Education, Research, and Quality Improvement: Educator Breakout session |

A Novel Early Mobilization Program in the ICU: A Quality Improvement Project FREE TO VIEW

Mark Weinreich, MD; Stephanie Dickason, PT; Emily Beffa, DPT; Jennifer Herman, OTR; Natalie Provenzale, MPH; Joanna Brown; Adam Diebold, RT; Razaq Badamosi, MD; Matthew Leveno, MD
Author and Funding Information

University of Texas Southwestern, Dallas, TX

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

Chest. 2016;150(4_S):637A. doi:10.1016/j.chest.2016.08.729
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SESSION TITLE: Educator Breakout session

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Medical intensive care unit (MICU) survivors often manifest significant impairments in physical function and diminished quality of life. Early mobilization (EM) programs have resulted in improved outcomes and wide spread implementation has been recommended by several professional societies. However, barriers to implementation are common and the need for increased resources is often chief among them. With this obstacle in mind, we implemented an EM program in our MICU as part of a quality improvement project.

METHODS: A multi-disciplinary team developed an EM protocol that was implemented at the Parkland MICU in January 2015. Therapists with the experience, knowledge, and interest in performing EM within the MICU population were selected to become dedicated MICU therapists. This was in comparison to the historical model of circulating therapists throughout the various hospital wards depending on general staffing needs. To rapidly identify appropriate EM candidates, the EM therapist led a brief morning rounds with the MICU charge nurse, bedside nurses, and respiratory therapists. Therapy referrals were then placed if the primary treating physician agreed with the lead therapist’s assessment. This referral system was in contrast to the prior model of physician only referral decision making. We collected data 6 months pre and post intervention. We collected data on the number and appropriateness of referrals, complete versus incomplete treatment sessions, time to first therapy session, and MICU length of stay. We also used the relational coordination scale to assess the quality of teamwork amongst therapists and nurses.

RESULTS: Comparing pre and post implementation time periods, referrals more than doubled (69 to 162), number of completed treatments more than tripled (134 to 490), inappropriate referrals decreased by 45%, and percentage of inappropriate referrals decreased from 19% to 3%. The time to first therapy session decreased from 7.7 to 4.1 days, and the MICU length of stay changed from 8.4 days to 5.8 days. The relational coordination scale average for MICU staff was, 4.7, as compared to 3.7 in controls.

CONCLUSIONS: Our multi-disciplinary early mobilization program resulted in patient’s receiving therapy interventions sooner and more frequently in the MICU stay and with a measureable improvement in the quality of teamwork amongst therapists and nurses. The increased therapist presence and productivity is likely due to three main factors: (1) the therapist staffing structure changed from rotating staffing to dedicated therapists with an interest in this patient population (2) we utilized a simple daily pre-round structure that changed referrals to being therapist initiated rather than relying on a traditional physician initiated referral structure which likely resulted in a reduction in low yield consults that historically consumed the therapists’ time, but provided no benefit to patients (3) improved quality of team work which is critical for achieving complex goals involving multiple disciplines.

CLINICAL IMPLICATIONS: We developed a novel early mobilization program as part of a quality improvement project in the MICU at a safety net hospital that increased therapist presence and productivity without the use of additional resources.

DISCLOSURE: The following authors have nothing to disclose: Mark Weinreich, Stephanie Dickason, Emily Beffa, Jennifer Herman, Natalie Provenzale, Joanna Brown, Adam Diebold, Razaq Badamosi, Matthew Leveno

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