Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit

Abstract

ObjectivesTo determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes. Design/MethodsProspective, longitudinal, comparative study using three time points (pre-, immediate post-intervention and 12-month post-intervention sustainability). Analyses included comparative statistics and multivariable modelling. Data were collected by clinical nurses, from administrative databases. Psychological health data were collected using a valid, reliable tool. SettingPatients treated in a 22-bed Neurological Intensive Care Unit of a quaternary-care medical centre. Outcome measuresHighest mobility level, length of stay, mortality, discharge disposition, quality metrics and psychological profile including depression, anxiety, and hostility. ResultsAmongst 260 pre-intervention, 377 post-implementation, and 480 twelve-month post-implementation patients (N = 1117) walking increased post-implementation and was sustained at the eight-month assessment, p < .001. After multivariable adjustment, unit and hospital length of stay and psychological distress were reduced compared to the pre-early mobility programmes (all p < .001). There were no differences in discharge disposition (i.e., home vs skilled nursing facility), mortality or quality metrics. ConclusionOngoing implementation of an early mobility programme in a neurological intensive care environment led to sustained improvement in patients’ level of mobility, length of unit and hospital stay, depression, anxiety and hostility levels.