Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative

Jodi M Herbsman; Michael D'Agati; Daniella Klein; Siobhan O'Donnell; John R Corcoran; Tiffany D Folks; Yasir M Al-Qaqaa

doi:10.1097/pq9.0000000000000256

Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative

Pediatr Qual Saf. 2020 Jan 31;5(1):e256. doi: 10.1097/pq9.0000000000000256. eCollection 2020 Jan-Feb.

Authors

Jodi M Herbsman¹, Michael D'Agati¹, Daniella Klein¹, Siobhan O'Donnell¹, John R Corcoran¹, Tiffany D Folks², Yasir M Al-Qaqaa³

Affiliations

¹ Rusk Rehabilitation, NYU Langone Health, New York, N.Y.
² Department of Nursing, NYU Langone Health, New York, N.Y.
³ Department of Pediatrics, NYU Langone Health, New York, N.Y.

Abstract

Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients.

Methods: We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing.

Results: All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05).

Conclusions: This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.