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Improving Outcomes by Integrating Early Mobility Into Intensive Care
Education, Research, and Quality Improvement SESSION TITLE: Education, Research, and Quality Improvement SESSION TYPE: Original Investigation Poster Discussion PRESENTED ON: Monday, October 24, 2016 at 12:00 PM - 01:30 PM
EDUCATION, RESEARCH, AND QUALITY IMPROVEMENT
Improving Outcomes by Integrating Early Mobility Into Intensive Care Mary Ayad MBBCh* Khalid Almoosa MD; and Bela Patel MD UTHSC, Houston, TX PURPOSE: Prolonged Immobilization is one of the most significant factors contributing to the long term complications in the intensive care unit (ICU) despite ample evidence available indicating that early mobilization improves multiple clinical outcomes, costs and patient satisfaction. We aimed to determine if integrating early mobility in the ICU will improve immediate outcomes related to the overuse of sedation, RASS score, and the likelihood of re-intubation. METHODS: We conducted a quality improvement project at the Memorial Hermann hospital (MHH) transplant surgical ICU (TSICU) from July 2014 to June 2015 following the Six Sigma D-M-A-I-C (Define-Measure-Analyze-Improve-Control) format. All intubated patients on mechanical ventilation admitted to the TSICU requiring more than 1 day stay were included in the study. Baseline qualitative and quantitative data were collected for a 3 month period. Subsequent interventions included: education and training of staff on mobility, reducing practices that hinder mobility (over sedation), education and involvement of patient’s families, and consultation of physical therapy (PT). A control phase will sustain the changes made by introducing controls for these changes and monitoring them by regular data collection and evaluation. Outcomes were measured to determine improved process measures such as frequency/duration/grade/type of mobility, in addition to RASS score, days sedated, and initiation of PT consultation. RESULTS: Between July 2014 and June 2015 92 patients in the TSICU at MHH were mechanically ventilated and included in the study. Before implanting the control measures the average mobility per patient was 0.6 hours which increased to 2.92 hours after implanting the measures. In addition, the percent of PT consultation also increased from 5.4% to 11.3%. This resulted in a decrease in the percent of days sedated from 78.2% to 53.1% and an improved RASS score (-1 to 0) for mechanically ventilated patients from 19.1% to 18.38%. The percent of patients re-intubated also decreased from 13.5% to 3.9%. CONCLUSIONS: Our data suggest that this quality improvement project resulted in an increase in the mobility in the TSICU patients, a decrease in the percent of days sedated, improved RASS score, decreased the likelihood of re -intubation and increased initiation of PT consultation. CLINICAL IMPLICATIONS: Encouraging early mobilization and PT consultation in the ICU will reduce overuse of sedation and its potential complications. In addition to reducing the long term complications that have emerged over the past decade in the ICU including acquired neuromuscular weakness, weight loss, functional impairment, and the use of rehab this will result in an overall improvement in the patient’s satisfaction with the care provided. DISCLOSURE: The following authors have nothing to disclose: Mary Ayad, Khalid Almoosa, Bela Patel No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.698
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
606A
[
150#4S CHEST OCTOBER 2016
]
EDUCATION, RESEARCH, AND QUALITY IMPROVEMENT
Improving Outcomes by Integrating Early Mobility Into Intensive Care Mary Ayad MBBCh* Khalid Almoosa MD; and Bela Patel MD UTHSC, Houston, TX PURPOSE: Prolonged Immobilization is one of the most significant factors contributing to the long term complications in the intensive care unit (ICU) despite ample evidence available indicating that early mobilization improves multiple clinical outcomes, costs and patient satisfaction. We aimed to determine if integrating early mobility in the ICU will improve immediate outcomes related to the overuse of sedation, RASS score, and the likelihood of re-intubation. METHODS: We conducted a quality improvement project at the Memorial Hermann hospital (MHH) transplant surgical ICU (TSICU) from July 2014 to June 2015 following the Six Sigma D-M-A-I-C (Define-Measure-Analyze-Improve-Control) format. All intubated patients on mechanical ventilation admitted to the TSICU requiring more than 1 day stay were included in the study. Baseline qualitative and quantitative data were collected for a 3 month period. Subsequent interventions included: education and training of staff on mobility, reducing practices that hinder mobility (over sedation), education and involvement of patient’s families, and consultation of physical therapy (PT). A control phase will sustain the changes made by introducing controls for these changes and monitoring them by regular data collection and evaluation. Outcomes were measured to determine improved process measures such as frequency/duration/grade/type of mobility, in addition to RASS score, days sedated, and initiation of PT consultation. RESULTS: Between July 2014 and June 2015 92 patients in the TSICU at MHH were mechanically ventilated and included in the study. Before implanting the control measures the average mobility per patient was 0.6 hours which increased to 2.92 hours after implanting the measures. In addition, the percent of PT consultation also increased from 5.4% to 11.3%. This resulted in a decrease in the percent of days sedated from 78.2% to 53.1% and an improved RASS score (-1 to 0) for mechanically ventilated patients from 19.1% to 18.38%. The percent of patients re-intubated also decreased from 13.5% to 3.9%. CONCLUSIONS: Our data suggest that this quality improvement project resulted in an increase in the mobility in the TSICU patients, a decrease in the percent of days sedated, improved RASS score, decreased the likelihood of re -intubation and increased initiation of PT consultation. CLINICAL IMPLICATIONS: Encouraging early mobilization and PT consultation in the ICU will reduce overuse of sedation and its potential complications. In addition to reducing the long term complications that have emerged over the past decade in the ICU including acquired neuromuscular weakness, weight loss, functional impairment, and the use of rehab this will result in an overall improvement in the patient’s satisfaction with the care provided. DISCLOSURE: The following authors have nothing to disclose: Mary Ayad, Khalid Almoosa, Bela Patel No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.698
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
606A
[
150#4S CHEST OCTOBER 2016
]