(416) Early Mobility in Intensive Care Unit: A Quality Improvement Project

Introduction: The post-care effects of the ICU are prolonged and devastating due to increased risk of physical deconditioning and prolonged weakness. Prior to early mobility (EM) implementation, patients were typically mobilized only upon discharge from the ICU. This QI project was performed to implement EM in our 30-bed multidisciplinary ICU and to evaluate its impact.

Methods: A multidisciplinary EM committee was created. During the pre-intervention period (March 1, 2023, to May 31, 2023), a 10-question survey was administered to multiple interdisciplinary teams to gather information on current thoughts and barriers around EM in critical care. Based on the survey results, the EM protocol was created. The protocol recommended nurses assess RASS every shift, with specific nurse-driven mobility recommendations based on RASS. A 60-minute educational session was provided by PT to the ICU nurses. The intervention period ran from June 1, 2023, to July 1, 2023, and data were collected through March 31st, 2024. The primary outcome, hospital LOS, was compared between pre-and post-intervention groups.

Results: There were 77 patients in the pre-EM period and 105 patients in the post-EM period. The median hospital LOS in the pre- and post-EM periods were 26 (interquartile range [IQR] 17-44) and 31 (IQR 17-43), respectively, with a p-value of 0.82. The median number of days in the ICU, days on sedation, days on dexmedetomidine drip, and days intubated were not significantly different between the two groups. But, there was a statistically significant difference between the pre-and post-intervention groups on ordering of PT consult (74% vs. 87%, P=0.03).

Conclusions: Short-term implementation of EM did not improve clinical outcomes. Several barriers were identified in the pre-intervention survey, which likely contributed to its lack of effectiveness. Notably, 25% of respondents felt patients were too sick to ambulate, 31% felt they needed more training to mobilize their patients safely, 70% felt the need for more safety equipment (e.g., walkers/rollers), and 70% felt confident in knowing when to mobilize their patients. The significant increase in PT consults indicates a heightened awareness of EM in the ICU. However, future work will focus on breaking down barriers for the primary team to apply EM independently of PT.