David McWilliams1, Catherine Snelson2, Hannah Goddard3, Ben Attwood4. 1. Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom. Electronic address: david.mcwilliams@uhb.nhs.uk. 2. Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom. 3. Physiotherapy, South Warwickshire NHS Foundation Trust, Warwick Hospital, Lakin Road, Warwick CV34 5BW, Warwickshire, United Kingdom. 4. Critical Care, South Warwickshire NHS Foundation Trust, Warwick Hospital, Lakin Road, Warwick CV34 5BW, Warwickshire, United Kingdom.
Abstract
OBJECTIVES: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. DESIGN: Fifteen-month prospective before/after quality improvement project. SETTING: Seven-bed mixed dependency critical care unit. PARTICIPANTS: 209 patients admitted to critical care for ≥4 days. INTERVENTION: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. MAIN OUTCOME MEASURE: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. RESULTS: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). CONCLUSION: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.
OBJECTIVES: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. DESIGN: Fifteen-month prospective before/after quality improvement project. SETTING: Seven-bed mixed dependency critical care unit. PARTICIPANTS: 209 patients admitted to critical care for ≥4 days. INTERVENTION: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. MAIN OUTCOME MEASURE: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. RESULTS: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). CONCLUSION: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.
Authors: Marco Maciel-Monteon; Jorge Limon-Romero; Carlos Gastelum-Acosta; Yolanda Baez-Lopez; Diego Tlapa; Manuel Iván Rodríguez Borbón Journal: PLoS One Date: 2020-01-03 Impact factor: 3.240