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A HFMEA-driven Standardized Mobilization Protocol Reduces Adverse Events During Early Out-of-bed Activity in
Yun-Chen Tsai1, Shiou-Ying Chang2, Ting-Yuan Sheu1
1Division of Physical Therapy, Department of Physical Medicine and Rehabilitation.
Journal of Patient Safety
|April 21, 2026
Summary
Implementing a standardized early mobilization workflow in neurocritical care significantly reduced adverse events and improved safety. This approach enhances patient recovery and provides a reliable model for intensive care unit rehabilitation.
Area of Science:
- Neurocritical Care
- Quality Improvement
- Patient Safety
Background:
- Early mobilization in neurocritical care aids neurological recovery but is often delayed due to safety concerns.
- Existing intensive care unit (ICU) mobilization guidelines lack neurocritical-specific recommendations, leading to inconsistent practices and risks.
- System-level strategies are needed to mitigate risks associated with early mobilization in neurocritical care.
Purpose of the Study:
- To evaluate the impact of a standardized, safety-engineered early mobilization workflow on adverse events and process reliability in a neurotrauma ICU.
- To implement and assess a Healthcare Failure Mode and Effects Analysis (HFMEA)-guided protocol for early mobilization.
Main Methods:
- A prospective, single-center pre-post quality improvement study was conducted in a tertiary neurotrauma ICU.
- A standardized workflow was developed using HFMEA to address potential failure modes in early mobilization.
- Key metrics including mobilization-related adverse events, ventilator-tubing dislodgement, and screening accuracy were compared pre- and post-implementation.
Main Results:
- Adverse event rates decreased by 66.2% (1.89% to 0.64%), with a statistically significant reduction (P=0.023).
- Ventilator-tubing dislodgement decreased from 0.42% to 0%, and eligibility screening accuracy improved from 85% to 95% (P<0.001).
- Structured interdisciplinary handoff completion rose from 30% to 100%, and real-time safety reporting increased from 72% to 95%.
Conclusions:
- An HFMEA-guided standardized early mobilization workflow effectively reduced adverse events and enhanced process reliability in neurocritical care.
- Treating early mobilization as a safety-engineered process promotes safer and more consistent ICU rehabilitation.
- This study offers a reproducible model for improving patient safety in neurocritical care settings.
