UTILIZATION OF ELECTRONIC HEALTH RECORD TO IMPROVE MOBILITY IN A SURGICAL ICU

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Early mobilization in intensive care units has become standard practice with widely recognized benefits. Achieving inter-professional communication among clinicians, nurses, and physical therapists can be challenging. We hypothesize that development of a novel integrated electronic health record (EHR) tool will help in increased mobility and decreased hospital length of stay (LOS) by clearly communicating patient’s mobility goals of the day with various disciplines. METHODS: A new EHR tool was designed to capture and track mobility goals established on rounds and achievements documented by both nursing staff and physical therapists. We conducted a retrospective cohort study comparing mobility progression of critically ill patients during surgical intensive care unit (SICU) stay for 3 months prior (November to January 2017-2018) and 3 months after (November to January 2018-2019) implementation of the new tool. Data collected included total number of physical therapy (PT) visits, mobility progression, and hospital LOS. RESULTS: We reviewed 298 SICU patients in our retrospective cohort study; 172 pre-intervention, 126 post-intervention. In the pre-intervention cohort, 95/172 (55%) patients progressed to the preset mobility level while 83/126 (66%) progressed in the post-intervention group (p=.06). The mean hospital LOS decreased from 35.26 days pre-intervention to 26.84 days post-intervention (p = 0.17). The number of total PT visits increased from 202 total visits pre-intervention to 245 post-intervention although this was not statistically significant (p = 0.09). The number of PT orders placed in the ICU in the pre-intervention group was 142 and in the post-intervention group was 187 (p=.0005). CONCLUSIONS: Mobility goals can vary on daily basis for an individual patient. Inability to establish these daily goals and communicate them to staff leads to inconsistent expectations and can hinder a patient’s progress. By clearly identifying mobility goals on rounds, tracking them and their achievement with reasons goals were not met, a deeper insight into the patient’s functional status and barriers for progression is gained. We utilized EHR tools including specific flowsheets, reports, dashboard and graphic displays to capture these elements. This intervention led to improvement in interdisciplinary communication and tracking, increased number of PT visits, improved mobility progression approaching statistical significance, and decreased hospital LOS. CLINICAL IMPLICATIONS: Utilization of integrated EHR mobility tools as an effective communication resource led to increased utilization of PT, increase in mobility progression, and improved hospital LOS. DISCLOSURES: No relevant relationships by Adel Bassily-Marcus, source=Web Response No relevant relationships by Roopa Kohli-Seth, source=Web Response No relevant relationships by Scott Leikin, source=Web Response No relevant relationships by Anthony Manasia, source=Web Response No relevant relationships by Amira Mohamed, source=Web Response No relevant relationships by John Oropello, source=Web Response