Abstract WP496: Early Mobility in the Neurosurgical Intensive Care Unit: A Quality Improvement Project

Abstract

Bed rest is prevalent among patients in neurosurgical intensive care units (NSICU). The most common conditions that contribute to bed rest are acute ischemic or hemorrhagic strokes, neuromuscular weaknesses, spinal instability, post endovascular interventions, neurobehavioral disturbances, and mechanical ventilation. The immobility of bed rest causes numerous complications including critical illness myopathy, deep venous thrombosis (DVT), pressure ulcers, pulmonary dysfunction, bone demineralization, alterations in peripheral muscle mass, joint contractures, and general deconditioning. The purpose of this evidence-based quality improvement (QI) project was to evaluate the effectiveness of a practice change, which was the implementation of an early mobility program in the NSICU. The study design for this project was a retrospective analysis of a previous practice change. The algorithm for the practice change was specially designed for patients with neurological illnesses in the ICU. The number of days during which patients had mobility interventions, the frequency of mobility interventions, Functional Status Score for ICU (FSS-ICU), NSICU Length of Stay (LOS), the incidence of ICU delirium, and ventilator days were compared pre and post intervention. This QI project was conducted in an academic neuroscience hospital with 146 beds and receives referral patients from all over the nation. The principal investigator (PI) anticipated an increase in the physical activity, thereby improving the functional and cognitive outcomes of critically ill patients admitted to the NSICU through this QI project. The outcomes of this QI project were assessed and the results revealed a statistically significant improvement in the frequency of out of bed mobility activities (number of days patients had mobility interventions, p = 0.03; frequency of mobility steps, p = 0.002). The difference in mean LOS ( p = 0.5), FSS-ICU ( p = 0.7), and ICU delirium ( p = 0.99) did not prove any statistical significance. The intervention of early mobilization in the NSICU is safe and feasible to implement, providing a structured plan for increasing the activity level of neurologically injured patients.