A Quality Improvement Initiative to Optimize Early Mobilization in Acute Intracerebral Hemorrhage: A Pre-Post...

Area of Science:

• Neurology
• Critical Care Medicine
• Rehabilitation

Background:

• Primary intracerebral hemorrhage (ICH) is associated with significant mortality and disability.
• Early mobilization is crucial for recovery but often delayed due to concerns about patient stability.
• Critically ill ICH patients require careful management to balance mobility benefits with safety.

Purpose of the Study:

• To assess the impact of a structured early mobilization protocol on functional mobility in critically ill ICH patients.
• To evaluate the effect of the protocol on the incidence of adverse events.
• To determine if early mobilization influences length of stay in the intensive care unit (ICU) and hospital.

Main Methods:

• Retrospective pre-post study design involving 192 patients with ICH (ICH score 0-4).
• Comparison of standard care (pre-implementation) versus a standardized mobility protocol (post-implementation).
• The protocol included time-based stratification, neurological thresholds, and safety criteria for activity progression.

Main Results:

• Patients in the post-implementation group achieved higher Modified ICU Mobility Scale (MIMS) scores at ICU discharge.
• A greater proportion of patients in the post-implementation group achieved out-of-bed sitting.
• Non-serious adverse events were significantly reduced in the post-implementation group.

Conclusions:

• A structured early mobilization pathway facilitates safer and earlier mobility in critically ill ICH patients.
• The protocol demonstrated improved functional outcomes within the ICU.
• While mobility benefits are evident, trends in length of stay require cautious interpretation due to non-significant findings.