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. 2016 Mar 18;150(3):722–731. doi: 10.1016/j.chest.2016.03.003

Table 3.

Summary of Selected QI Projects of Early Mobilization and Rehabilitation Interventions in the ICU

QI Project Location/Year ICU Patient Population and Time Frame Selected Aspects of the QI Intervention Key Outcomes (Before vs After QI)
Johns Hopkins Hospital48/2010 16-bed MICU N = 576, QI executed over 4 mo
  • •

    Adopting the 4Es modela of QI49, 50

  • •

    Changing default activity level from bed rest to as tolerated

  • •

    Discouraging sedation infusions for as needed boluses

  • •

    Establishing simple PT and OT and safety guidelines
  • •

    No. of PT and OT treatments in ICU, mean (1.6 vs 4.3; P < .05)

  • •

    ICU LOS, mean (7 vs 5 d; P = .02)

  • •

    PT and OT treatment of sitting or greater (56% vs 78%; P = .03, based on a subset of 344 treatments)
University of California San Francisco51/2013 16-bed mixed ICU N = 373, QI executed over 9 mo
  • •

    Establishing an early mobilization working group, with monthly meeting

  • •

    Distributing standards for PT interventions and exclusion guidelines to all ICU staff

  • •

    Changing patient selection for PT to become an interprofessional process instead of being physician driven

  • •

    Assessing mobility daily in coordination with nurses, physical and respiratory therapists
  • •

    Patients ambulating (43% vs 50%; P = .004)

  • •

    Patients discharged home (55% vs 77%; P < .001)

  • •

    ICU LOS, median (6 vs 4 d; P = .011)
University of Alabama at Birmingham52/2013 28-bed trauma and burns ICU N = 2,176, QI executed over 12 mo
  • •

    PT referral on ICU admission

  • •

    4-level mobility program ranging from positioning and PROM to walking

  • •

    Daily rounds, mobility flow sheets
  • •

    PT billable units per day, mean (11 vs 21)

  • •

    ICU LOS, mean (11 vs 10 d; P = .33)

  • •

    Prevalence of deep vein thrombosis (11% vs 7%; P ≤ .001)

  • •

    Prevalence of pneumonia (28% vs 22%; P ≤ .01)
University Hospitals Birmingham, England53/2015 75-bed mixed ICU N = 582, MV ≥ 5 d, QI executed over 12 months
  • •

    Adopting the 4Es model of QI49, 50

  • •

    Creating a critical care physiotherapy subteam

  • •

    Transcribing rehabilitation plans onto wall charts

  • •

    Conducting weekly rehabilitation meetings
  • •

    Time to first mobilization, mean (9 vs 6 d; P = .001)

  • •

    ICU LOS, mean (17 vs 14 d; P = .007)

PROM = passive range of motion; QI = quality improvement; RN = registered nurse; See Table 1 legend for expansion of other abbreviations.

a

The 4Es model is part of a structured quality improvement model that consists of engaging and educating stakeholders followed by executing the intervention and then evaluating results in an iterative manner