SESSION TITLE: Clinical Improvement Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: As more patients survive the intensive care unit (ICU), there is more focus on their functional recovery. Studies have incidentally noted reduced lengths of stay (LOS) among those who receive early mobility, which will be the primary focus of our study. We hypothesized that by providing our veterans with an early ICU mobility program, we will be able to improve their LOS and mobility outcomes, which we uniquely measured as a function of LOS through the Functional Independent Measure (FIM) Efficiency.
METHODS: We collaborated with our colleagues from physical medicine and rehabilitation to develop a four-phase, progressive mobility program that we adapted from multiple published studies. We incorporated our program as a standard section of the ICU admission order set that the admitting resident must address; unless the veteran has one of our exclusionary diagnoses. Physical therapists then evaluate the veteran within the first 48hours. For our mechanically ventilated patients, we updated our sedation protocol to ensure adequate sedation interruption for PT evaluation. We conducted a cohort study to evaluate our program by comparing LOS and FIM Efficiency (the difference in FIM on the initial and final PT evaluation divided by the LOS). The mobility cohort (MC) consisted of 16 veterans who qualified for the protocol in February-March of 2013. The standard cohort (SC) consisted of 16 veterans who were in the ICU in the same months in 2012 and did not receive PT in the ICU.
RESULTS: Veterans in the MC received significantly higher number of PT/OT sessions (80) than the SC (42); (t-test p=0.04). APACHE II score for the MC and SC were 12.1 and 13.8 respectively (t-test p=0.33). The ICU LOS in the MC and SC were 4.5 days and 5 days (t-test p=0.13). The overall LOS in the MC and SC was 7.8 days and 10.8 days respectively (t-test p=0.13). The MC and SC FIM efficiency was 0.67 and 0.26 respectively (t-test p=0.13). No falls or loss of indwelling catheters was observed among our mobility cohort.
CONCLUSIONS: While our preliminary data was not statistically significant, we expect our findings to achieve significance as we enroll more veterans. We will be among the first studies to employ FIM efficiency as measure of disability to evaluate patients in an early ICU mobility program.
CLINICAL IMPLICATIONS: The promising trends seen in our data support the need for an early ICU mobility program. Given its substantial benefits, we expect this to be the new standard of care in our ICU and affiliate institutions.
DISCLOSURE: The following authors have nothing to disclose: Gayathri Sathiyamoorthy, Changwan Ryu, Karen Huges, Cynthia Massara, Stephen Lebduska, Erik Boergesson, Pratibha Kaul, Joan Mitchell
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