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ICU Early Mobilization: From Recommendation to Implementation at Three Medical Centers

Engel, Heidi J. PT, DPT1; Needham, Dale M. MD, PhD2; Morris, Peter E. MD3; Gropper, Michael A. MD, PhD4

doi: 10.1097/CCM.0b013e3182a240d5
Creating and Implementing the 2013 ICU Pain, Agitation, and Delirium Guidelines for Adult Icu Patients

Objective: To compare and contrast the process used to implement an early mobility program in ICUs at three different medical centers and to assess their impact on clinical outcomes in critically ill patients.

Design: Three ICU early mobilization quality improvement projects are summarized utilizing the Institute for Healthcare Improvement framework of Plan-Do-Study-Act.

Intervention: Each of the three ICU early mobilization programs required an interprofessional team-based approach to plan, educate, and implement the ICU early mobility program. Champions from each profession—nursing, physical therapy, physician, and respiratory care—were identified to facilitate changes in ICU culture and clinical practice and to identify and address barriers to early mobility program implementation at each institution.

Setting: The medical ICU at Wake Forest University, the medical ICU at Johns Hopkins Hospital, and the mixed medical-surgical ICU at the University of California San Francisco Medical Center.

Results: Establishing an ICU early mobilization quality improvement program resulted in a reduced ICU and hospital length of stay at all three institutions and decreased rates of delirium and the need for sedation for the patients enrolled in the Johns Hopkins ICU early mobility program.

Conclusion: Instituting a planned, structured ICU early mobility quality improvement project can result in improved outcomes and reduced costs for ICU patients across healthcare systems.

1Department of Rehabilitative Services, University of California San Francisco Medical Center, San Francisco, CA.

2Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.

3Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston Salem, NC.

4Critical Care Medicine, University of California San Francisco Medical Center, San Francisco, CA.

Dr. Engel holds a consultancy with the Institute for Healthcare Improvement. Dr. Morris has received travel support from Hill-Rom and Covidien. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins