Alice Chiarici1, Elisa Andrenelli2, Oletta Serpilli3, Matteo Andreolini3, Silvia Tedesco4, Giovanni Pomponio4, Maria Mattea Gallo5, Claudio Martini5, Roberto Papa5, Michela Coccia3, Maria Gabriella Ceravolo1. 1. Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy. 2. Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy. Electronic address: elisa.andrenelli@gmail.com. 3. Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy. 4. Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy. 5. Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy.
Abstract
OBJECTIVE: To investigate the effectiveness, feasibility, and safety of an evidence-based rehabilitation care pathway in the intensive care unit (ICU) in different patient populations. DESIGN: Observational prospective cohort study, with retrospective controls. SETTING: ICUs of a university hospital. PARTICIPANTS: Patients admitted between April 1, 2015, and June 30, 2015, were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014. The number of patients studied (N=285) included 152 in the prospective group and 133 in the retrospective group. INTERVENTIONS: The prospective cohort benefited of a rehabilitation care pathway based on (1) interdisciplinary teamwork; (2) early customized and goal-oriented rehabilitation; (3) daily functional monitoring and treatment revision; (4) agreed discharge policy; and (5) continuity of care. The retrospective cohort underwent usual care. MAIN OUTCOME MEASURES: Included the following: (1) proportions of patients undergoing rehabilitation team evaluation; (2) latency between patient admission to ICUs and rehabilitation team assessment; (3) proportions of patients undergoing rehabilitation treatment during ICU stay; (4) latency between the patient admission to ICUs and rehabilitation start; (5) ICU stay and total acute hospital stay; and (5) proportion of ventilator-free days out of ICU stay. RESULTS: The novel rehabilitation care pathway led to (1) an increased proportion of patients receiving rehabilitative assessment (P<.0001); (2) a decreased latency from ICU admission to both rehabilitation team assessment and rehabilitation start (P<.0001); (3) an increased proportion of patients undergoing rehabilitation (P<.0001); (4) a shorter length of stay in ICUs (P<.0001) and in hospital (P=.047); and (5) a shorter mechanical ventilation duration (P<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed. CONCLUSIONS: An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost effective.
OBJECTIVE: To investigate the effectiveness, feasibility, and safety of an evidence-based rehabilitation care pathway in the intensive care unit (ICU) in different patient populations. DESIGN: Observational prospective cohort study, with retrospective controls. SETTING: ICUs of a university hospital. PARTICIPANTS: Patients admitted between April 1, 2015, and June 30, 2015, were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014. The number of patients studied (N=285) included 152 in the prospective group and 133 in the retrospective group. INTERVENTIONS: The prospective cohort benefited of a rehabilitation care pathway based on (1) interdisciplinary teamwork; (2) early customized and goal-oriented rehabilitation; (3) daily functional monitoring and treatment revision; (4) agreed discharge policy; and (5) continuity of care. The retrospective cohort underwent usual care. MAIN OUTCOME MEASURES: Included the following: (1) proportions of patients undergoing rehabilitation team evaluation; (2) latency between patient admission to ICUs and rehabilitation team assessment; (3) proportions of patients undergoing rehabilitation treatment during ICU stay; (4) latency between the patient admission to ICUs and rehabilitation start; (5) ICU stay and total acute hospital stay; and (5) proportion of ventilator-free days out of ICU stay. RESULTS: The novel rehabilitation care pathway led to (1) an increased proportion of patients receiving rehabilitative assessment (P<.0001); (2) a decreased latency from ICU admission to both rehabilitation team assessment and rehabilitation start (P<.0001); (3) an increased proportion of patients undergoing rehabilitation (P<.0001); (4) a shorter length of stay in ICUs (P<.0001) and in hospital (P=.047); and (5) a shorter mechanical ventilation duration (P<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed. CONCLUSIONS: An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost effective.
Authors: Kirby P Mayer; Amanda R Hornsby; Victor Ortiz Soriano; Timothy C Lin; Jennifer T Cunningham; Hanwen Yuan; Caroline E Hauschild; Peter E Morris; Javier A Neyra Journal: Kidney Int Rep Date: 2019-10-11
Authors: C Hobeika; F Cauchy; E Weiss; S Chopinet; A Sepulveda; F Dondero; L Khoy-Ear; B Grigoresco; S Dokmak; F Durand; B Le Roy; C Paugam-Burtz; O Soubrane Journal: BJS Open Date: 2021-01-08
Authors: Alessandro Schaer; Oskar Helander; Francesco Buffa; Alexis Müller; Kevin Schneider; Henrik Maurenbrecher; Barna Becsek; George Chatzipirpiridis; Olgac Ergeneman; Salvador Pané; Bradley J Nelson; Nina Schaffert Journal: Sensors (Basel) Date: 2021-12-04 Impact factor: 3.576