Abstract
OBJECTIVES: ICU-acquired weakness affects 50% of critically ill patients. Early mobility programs have been shown to improve functional status at hospital discharge, shorten duration of mechanical ventilation, prevent delirium, and reduce length of stay. Despite these benefits, early mobility is one of the most difficult parts of the ABCDEF bundle to incorporate into practice. This project sought to use a multidisciplinary intervention to improve mobility in the ICU.
DESIGN: Randomized, pragmatic design quality improvement study.
SETTING: Two ICUs at a large academic medical center between July 2023 and February 2024.
PATIENTS: Five hundred seventy-four ICU patients with 271 in the intervention ICU and 276 in the control ICU.
INTERVENTIONS: A multidisciplinary quality improvement initiative focused on increasing education, raising awareness, and addressing barriers.
MEASUREMENTS AND MAIN RESULTS: Our primary outcome was achievement of an intensity-specific mobility goal with nursing staff on a patient-day level. A difference-in-differences model was used to evaluate the association between the mobility intervention and mobility goal achievement. The percentage of daily mobility goals met increased from 48.6% pre-intervention to 65.4% post-intervention in the intervention ICU (p < 0.001). There was no significant difference in daily mobility goal adherence between the intervention and control ICU pre-intervention, but post-intervention, the intervention ICUs adherence was significantly higher (65.4% vs. 43.0%; p < 0.001). After controlling for demographic, clinical, and ICU characteristics, the intervention ICU was 1.96 times more likely to reach the daily mobility goal on a patient-day level (p = 0.017). There was no significant change in ICU length of stay, inpatient length of stay, discharge to home, or in-hospital mortality between patients treated in the intervention vs. control ICU.
CONCLUSIONS: A multidisciplinary quality improvement initiative can improve adherence to daily mobility goals.