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PICU Move! Improving Early Mobilization in a Large Pediatric Intensive Care Unit
Jacqueline Zedalis1, Katrina Budzynski2, Meghan Burkhardt3
1From the Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pa.
Insights
Early mobilization in pediatric intensive care units (PICU) improved with a new protocol. This initiative safely reduced patient activity time and increased therapy consultations.
Area of Science:
- Pediatric Critical Care Medicine
- Rehabilitation Therapy
- Healthcare Systems Improvement
Background:
- Early mobilization is recommended in pediatric intensive care units (PICUs).
- Standardized protocols are needed to guide mobilization based on patient acuity.
- Implementing such protocols requires both systems and individual-level interventions.
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 changes in therapy utilization and patient activity timing.
Main Methods:
- A standardized early mobilization protocol, "PICU Move!," using Critical Care Illness Levels (CCILs) was implemented.
- Interventions included electronic health record integration, opt-out therapy consultations, and staff education.
- Process measures (compliance, consultations) and outcome measures (time to activity, therapy contacts) were tracked.
Main Results:
- High compliance with CCIL ordering (95.9%) and increased PT/OT consultations (from 38.8% to 82.6% and 34.3% to 81.2%).
- Significant increase in multiple PT/OT contacts and a reduction in time to first registered nurse activity.
- No safety events related to early mobilization were reported.
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.
- This approach demonstrates a successful model for improving pediatric critical care patient mobility.
Introduction:
Guidelines support early mobilization in the pediatric intensive care unit (PICU). In our 75-bed PICU, we implemented "PICU Move!," a standardized early mobilization protocol using "Critical Care Illness Levels" (CCILs) that specify mobilization goals based on patients' medical status.
Methods:
We used systems-based interventions (electronic health record order sets and workflows, opt-out therapy consultations, and progressive mobilization equipment) and person-based interventions (education, mobility champions, simulations, and mobility rounds). Process measures were CCIL ordering compliance, early mobilization goal compliance, and the proportion of admissions with a length of stay (LOS) ≥ 72 hours that included consultations with physical therapy (PT) and occupational therapy (OT). Outcome measures included time to first registered nurse activity documentation (all admissions and admissions with LOS ≥72 h) and admissions with LOS ≥72 hours with multiple PT/OT contacts. Balancing measures included safety event reports related to early mobilization activities, unplanned extubations, and falls.
Results:
During the intervention period (July 2023-December 2024), median monthly CCIL compliance was 95.9%, and early mobilization goal compliance was 49.4%. Compared to baseline, the average monthly proportion of admissions with LOS ≥72 hours with PT or OT consultation increased from 38.8% to 82.6% and from 34.3% to 81.2%, respectively. Multiple PT and OT contacts increased from 40.9% to 81.7% and from 37.7% to 70.8%, respectively. Time to first activity decreased from 21.6 to 19.6 hours (all admissions) and from 67.9 to 59.1 hours (admissions with LOS ≥72 h). There were no documented safety events related to early mobilization activities.
Conclusions:
In a large PICU, systems-based interventions, supplemented by person-based interventions, safely reduced time to first activity and increased the number of repeated PT/OT contacts.
