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A Progressive Early Mobilization Program Is Significantly Associated With Clinical and Economic Improvement

A Single-Center Quality Comparison Study

Liu, Keibun MD1; Ogura, Takayuki MD, PhD1; Takahashi, Kunihiko PhD2; Nakamura, Mitsunobu MD, PhD1; Ohtake, Hiroaki MD, PhD3; Fujiduka, Kenji MD1; Abe, Emi RN, CA4; Oosaki, Hitoshi PT3; Miyazaki, Dai MD1; Suzuki, Hiroyuki MD1; Nishikimi, Mitsuaki MD5; Komatsu, Mamoru MD1; Lefor, Alan Kawarai MD, MPH, PhD6; Mato, Takashi MD, PhD7

doi: 10.1097/CCM.0000000000003850
Online Clinical Investigation: PDF Only
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Objectives: To determine whether a progressive early mobilization protocol improves patient outcomes, including in-hospital mortality and total hospital costs.

Design: Retrospective preintervention and postintervention quality comparison study.

Settings: Single tertiary community hospital with a 12-bed closed-mixed ICU.

Patients: All consecutive patients 18 years old or older were eligible. Patients who met exclusion criteria or were discharged from the ICU within 48 hours were excluded. Patients from January 2014 to May 2015 were defined as the preintervention group (group A) and from June 2015 to December 2016 was the postintervention group (group B).

Intervention: Maebashi early mobilization protocol.

Measurements and Main Results: Group A included 204 patients and group B included 187 patients. Baseline characteristics evaluated include age, severity, mechanical ventilation, and extracorporeal membrane oxygenation, and in group B additional comorbidities and use of steroids. Hospital mortality was reduced in group B (adjusted hazard ratio, 0.25; 95% CI, 0.13–0.49; p < 0.01). This early mobilization protocol is significantly associated with decreased mortality, even after adjusting for baseline characteristics such as sedation. Total hospital costs decreased from $29,220 to $22,706. The decrease occurred soon after initiating the intervention and this effect was sustained. The estimated effect was $–5,167 per patient, a 27% reduction. Reductions in ICU and hospital lengths of stay, time on mechanical ventilation, and improvement in physical function at hospital discharge were also seen. The change in Sequential Organ Failure Assessment score and Sequential Organ Failure Assessment score at ICU discharge were significantly reduced after the intervention, despite a similar Sequential Organ Failure Assessment score at admission and at maximum.

Conclusions: In-hospital mortality and total hospital costs are reduced after the introduction of a progressive early mobilization program, which is significantly associated with decreased mortality. Cost savings were realized early after the intervention and sustained. Further prospective studies to investigate causality are warranted.

1Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.

2Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.

3Department of Rehabilitation Medicine, Japan Red Cross Maebashi Hospital, Maebashi, Japan.

4Department of Nursing, Intensive Care Unit, Japan Red Cross Maebashi Hospital, Maebashi, Japan.

5Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.

6Department of Surgery, Jichi Medical University, Tochigi, Japan.

7Department of Emergency Medicine, Jichi Medical University, Tochigi, Japan.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Oosaki disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This study was conducted in the ICU of the Japan Red Cross Maebashi Hospital.

For information regarding this article, E-mail: keiliu0406@gmail.com

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