PICU Move! Improving Early Mobilization in a Large Pediatric Intensive Care Unit

Area of Science:

• Pediatric Critical Care Medicine
• Rehabilitation Therapy
• Healthcare Systems Improvement

Background:

• Early mobilization is recommended in pediatric intensive care units (PICUs).
• Implementing standardized protocols can enhance patient outcomes.
• Standardized mobilization protocols require clear guidelines based on patient status.

Purpose of the Study:

• To implement and evaluate a standardized early mobilization protocol in a large PICU.
• To assess the impact of systems-based and person-based interventions on mobilization practices.
• To measure the effect of the protocol on patient activity, therapy utilization, and safety.

Main Methods:

• Implemented "PICU Move!," a protocol using Critical Care Illness Levels (CCILs).
• Utilized systems-based interventions (EHR order sets, opt-out consultations) and person-based interventions (education, simulations).
• Measured CCIL ordering compliance, goal compliance, therapy consultations, time to first activity, and safety events.

Main Results:

• Achieved high CCIL ordering compliance (95.9%) and increased early mobilization goal compliance (49.4%).
• Significantly increased physical therapy (PT) and occupational therapy (OT) consultations for long-stay patients (LOS ≥72 hours).
• Reduced time to first registered nurse activity documentation and increased repeated PT/OT contacts without safety events.

Conclusions:

• Systems-based interventions, supported by person-based strategies, effectively enhanced early mobilization in a large PICU.
• The "PICU Move!" protocol safely reduced patient activity delays and increased therapy engagement.
• Standardized protocols are crucial for optimizing rehabilitation and patient outcomes in pediatric critical care.