Education, Research, and Quality Improvement: Education, Research, and Quality Improvement II |

Combating Immobility in the ICU: A Model for Team-Based Approach to Improve the Mobility of the ICU Patient FREE TO VIEW

John Bessada, DO; Shiv Patel; Brendan Skeehan; Oddie Moghalu; Satin Zarkar; Aamir Gilani, MD
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Touro COM, Middletown, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):611A. doi:10.1016/j.chest.2016.08.703
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SESSION TITLE: Education, Research, and Quality Improvement II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To improve the mobility of patients before their discharge from the Intensive Care Unit at Orange Regional Medical Center (ORMC) at Middletown, New York.

METHODS: We used a Fishbone analysis to study the prevalent barriers to the early mobilization of patients in the ICU at ORMC. We devised an intervention plan based on the physical therapist participation in the daily multidisciplinary rounds in the ICU. Physical therapists made independent recommendations for selecting patients who could benefit from physical therapy. We collected data for the total number of physical therapy consults per month, mobility scores of the individual ICU patients undergoing physical therapy on a 10 points scale (Piva, 2015) and the average length of stay (LOS). Intervention plan started on September 2015. Data collected during post-intervention months September-November, 2015 was compared to the data from August 2015 (baseline month). We also performed a cost saving analysis for the ICU using a validated financial model (Lord RK1, 2013).

RESULTS: ICU Patients undergoing physical therapy in the intervention months showed higher morbidity as compared to the ICU patients who got physical therapy during baseline months (P<0.05). Despite this, a greater proportion of ICU patients undergoing physical therapy experienced an improvement in their mobility during the intervention months as compared to the baseline month. ICU patients in the intervention months also showed a significant improvement (P<0.05) in the average mobility scores at the time of discharge from the ICU as compared to the average mobility scores on the day of assessment. There was a significant decrease in the average LOS of the ICU in the intervention months as compared to the control months (P<0.05). There was no difference in the total number of ICU consults placed in the control month as compared to intervention months. The projected net savings from using the team model including the physical therapists were between $85,754 and $518,148 per year (Lord RK1, 2013).

CONCLUSIONS: Our team based approach including the physical therapists improved selection of patients with higher morbidity yet the same patients experienced significant improvement in their mobility prior to discharge from ICU. This invention indirectly reduced the average LOS in the ICU in the intervention months. This translated into significant overall cost savings for our ICU.

CLINICAL IMPLICATIONS: This quality improvement project demonstrates the impact of physical therapist participation in the multidisciplinary team rounds to improve quality of care in the ICU. References Lord RK1, M. C. (2013). ICU early physical rehabilitation programs: financial modeling of cost savings. Critical Care Medicine. Piva, S. e. (2015). The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical, surgical, and neurologic intensive care unit patients. Journal of Critical Care, 30(6), 1251-1257.

DISCLOSURE: The following authors have nothing to disclose: John Bessada, Shiv Patel, Brendan Skeehan, Oddie Moghalu, Satin Zarkar, Aamir Gilani

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