Early Mobilization Program Research Articles

Effects of an Electronic Health Record Tool on Team Communication and Patient Mobility: A 2-Year Follow-up Study.

Intensive care unit early mobility programs improve patients' functional status and outcomes. An electronic health record-based communication tool improved interprofessional communication within an early mobility program. Long-term sustainability of this communication tool has not been evaluated. Ineffective interprofessional communication was perceived as a barrier to success of an intensive care unit early mobility program at the project institution. An electronic health record-based communication tool was successfully implemented to improve communication. Sustaining the intervention is of continued importance. Longitudinal data were collected 2 years after initial implementation of the communication tool to evaluate its continued impact on patient outcomes and staff engagement with an intensive care unit early mobility program. Initial implementation of the electronic health record-based communication tool resulted in statistically and clinically significant improvements in patient and staff metrics. Compared with postimplementation data, 2-year longitudinal follow-up data revealed nonsignificant changes in patient outcomes (time from admission to mobility goal, mechanical ventilation duration, length of intensive care unit stay, and discharge disposition recommendations to higher independence levels). Staff reported continued use of the communication tool and positive perceptions of its impact on the intensive care unit early mobility program. Nonsignificant changes in patient outcomes may indicate sustainment of the effect of the communication tool's original implementation. Employing appropriate sustainment techniques is essential to maintain practice change. The electronic health record-based communication tool can improve interprofessional communication within an intensive care unit early mobility program, improving patient outcomes and staff teamwork.

510 5-Year Retrospective Analysis of a Vented Early Mobility Algorithm in the Burn ICU

IntroductionThe practice of early mobilization on mechanically ventilated patients in ICU settings has received significant attention within recent literature, however limited research to date has focused specifically on the burn population. The purpose of this single center retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine the safety and feasibility of early mobility programs in the burn population, expose limitations preventing mobility progression at our facility, and discuss unique challenges to early mobility with burn patients.MethodsA retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for all intubated patients from initial evaluation until each patient was either extubated or underwent a tracheostomy. Data was collected using the stages of the mobility algorithm.ResultsIn the 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average TBSA of 22.8%. Of these patients, 25 were transitioned to comfort care measures due to the extent of their burn injuries but were included in the review. The average intubated days were 8.05 days and the average length of stay was 26 days. No adverse events occurred during treatment with the algorithm. Stage 1: PROM/AROM was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with only 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) including: unstable medical status, agitation, sedation, cultured epithelial autograft placement, and orthopedic restrictions. Line placement, including femoral and pedal catheters , was also found to be a barrier to the use of our algorithm in 21% of held patient treatments.ConclusionsRetrospective analysis demonstrates that early mobilization during mechanical ventilation is safe and feasible with in the burn population despite challenges including airway stability, sedation, and line limitations. Dedicated burn therapy staff and team coordination is required to optimize management during the critical care stage of recovery and improve outcomes for survivors.

Is surgery the best treatment for elderly gastric cancer patients?

As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.

Building a culture of early mobilization in the pediatric intensive care unit-a nuts and bolts approach.

The culture of sedation and immobilization in the pediatric intensive care unit (PICU) is associated with PICU-acquired weakness, delirium, and poor functional, neurocognitive and psychosocial outcomes. A structured approach to introducing physical activity, as early as possible after PICU admission, may prevent these complications and optimize the holistic outcomes of critically ill children. Changing culture and introducing new clinical practice in PICU is complex, but can be approached systematically, using a “nuts and bolts” approach targeting the basic, practical considerations and essential required elements or components. Extending the construction analogy, this article reviews the relevant literature to describe the essential elements required to build and sustain a successful and safe early mobility program in the PICU. Effective early mobilization requires individual patient assessment and goal setting, using a collaborative inter-disciplinary, patient- and family-centered approach, to ensure mobility goals and physical activities are appropriate for the patient’s age, condition/s, premorbid function, strength, endurance and developmental level. Early mobility activities for the pediatric age spectrum include active or active-assisted range of motion exercises, neurodevelopmental play, use of mobility devices, in-bed exercises, transfers, sitting or standing tolerance, crawling, pre-gait activities, ambulation and activities of daily living, with a focus on play as function. Although there are few complete contraindications to early mobilization, appropriate precautions and preparation should be taken to mitigate potential safety concerns. Although there are many perceived barriers to early mobilization in the PICU, at the level of patient, provider, institution and knowledge translation; these are not objectively associated with increased risk during mobilization and can be overcome through an engaged process of practice change by all members of the interprofessional clinical team. Early mobility programs could be initiated in PICU as systematic quality improvement initiatives, with established processes to optimize structural, process and system elements and to provide continual feedback, measurement, benchmarking and collaboration; to ultimately impact on measurable patient outcomes. Early, graded, and individually prescribed mobilization should be considered as part of the standard PICU “package of care” for all critically ill and injured children, in order to improve their functional status and quality of life after PICU discharge.

Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme

Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient’s physical and psychological recovery following surgery. We observed that patients...

A multidisciplinary early mobility model for cardiac patients in coronary intensive care unit

Abstract Funding Acknowledgements This is an unfunded project Background Early mobilization is considered as a complex task in an intensive care unit (ICU) and patients are often on prolonged bed rest leading to physical deconditioning. Intensive care early mobility programs have been recognized to be safe and have shown positive outcomes. However, implementing early mobility program as a standard of care remains a challenge. Coronary Intensive Care Unit (CICU) provides complex care for cardiac critically ill patients. In February 2018, the CICU multidisciplinary team (MDT) started a quality improvement project to implement early mobility program in the unit. Purpose This project aimed to investigate the feasibility of implementing an Early Mobility Protocol in CICU to increase the number of patients mobilized to more than 95%. Secondary objective was to explore the impact of the protocol on the mobility level of the patients at the time of discharge or transfer from the CICU. Methods A multidisciplinary mobility task force including Physicians, nurses, physiotherapists and respiratory therapists was formed to analyze the barriers in implementing an early mobility program. A staff survey was conducted to identify the need for a standard early mobility protocol. Root cause analysis and Pareto analysis was done. An evidence based early mobility protocol was developed and implemented. All non-mechanical ventilated patients were included in the first phase and all mechanical ventilated patients were included in the second phase of the project. A standard ICU Mobility scale (IMS) was used for scoring the mobility level of the patients. This quality improvement project is based on "Institute for Healthcare Improvement" model. Periodical staff education and training programs about early mobilization were conducted to improve staff confidence. Change ideas were implemented using multiple Plan Do Study Act cycles. Results The total number of patients included from 1st March 2018 till 31st December 2019 was 2356. This included both the genders. In March 2018, only 68% of non-mechanical ventilated patients were mobilized, that reached to 88% by November 2018. This gradually increased to 100% in May 2019 and is currently sustained at 100%. In November 2019, only 50% of mechanical ventilated patients were mobilized which gradually increased to 66.66% and 75% in middle and end of December 2019. The mean IMS score at discharge or transfer from CICU was "8". From patient-family experience survey, 93.75% of patients perceived that the program was helpful in regaining mobility and 96.25% of patients felt that the program helped in regaining their autonomy. Conclusion The result shows that it is safe and feasible to implement an early mobility program in a Coronary Intensive Care Unit. A standardized mobility protocol can lead to efficient mobilization practice facilitating early transfers from ICUs without any complications. This could further enhance the collaboration of the MDT members leading to culture change in ICUs.

Early mobilization as a new pathway to improve functional mobility of cardiac patients in High dependency Unit

Abstract Funding Acknowledgements Non funded project Background Early mobilization as a multidisciplinary team approach in cardiac High Dependency Unit-B (HDU B) helps to reduce loss of muscle strength, decrease hospital length of stay, improve functional capacity, cognitive levels, enhances the quality of care, and helps to decrease the hospitals costs. Purpose Early mobilization means reducing the time of bed rest from admission to first activity. Based on this definition the project aimed to mobilize more than 95% of cardiac patients within 24 hours of admission by September 2019 in HDU B unit. Methods HDU B Initiated Early mobilization program as a part of Value improvement project (VIP). Experts from multidisciplinary team (MDT) worked together to improve the functional mobility of patients. A cross section survey was conducted to identify barriers for early mobility in the unit followed by analyzing barriers through Pareto chart. An early mobility flow chart (Level1-Passive, Level 2-Active assisted, Level 3-Active) framed in order to standardize the practice of mobilizing patients in HDU B. New changes were tested by using methodology of Plan Do Study Act. Staff education, training given regarding the implementation of early mobility protocol. Patients with mobility level 1 and 2 were identified by nurses, requested for Physiotherapy referral by Physicians. Nursing staff education on mobility assessment given an easy access of data about mobility level of patients in handoff communication, which guided the staff to decide on the need of PT consultation for each patient. In coordination with MDT team referral were also given even during weekend for the patients with mobility level 2. To engage patient and family in the early mobility program a new concept of END PYJAMA PARALYSIS was introduced. Patients with mobility level 3 were identified and encouraged to wear their own dress and move outside their room under supervision.This concept aims to build confidence in patients making them feel that they are ready to go home. Results With support and co-operation of the MDT, this project became a highly successful project in VIP. Initially 50% of the patients has been mobilized when the program was introduced in the ward during March 2019 which increased gradually to 90% at the end of the month. After introducing the flow chart, there was increase in 93.3% by April 2019. In addition to Physio referral it went to 100% at the end April 2019. End pyjama paralysis and weekend physio referral sustained the 100% compliance to Early mobility till the end of July 2019. Active interventions of the team helped to early mobilize by 100% till the end of September 2019 and currently it is in sustainable phase. Conclusion Early mobilization in HDU-B brought significant change in the culture of mobilization. Commitment, cooperation of MDT, a structural system and End pyjamas paralysis program are key factors of the success for the program that promoted patient safety and prevented adverse events.

Roles of Early Mobilization Program in Preventing Muscle Weakness and Decreasing Psychiatric Disorders in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Cohort Study.

Although many coronavirus 2019 patients have experienced persistent symptoms and a long-term decline in quality of life after discharge, the details of these persistent symptoms and the effect of early rehabilitation are still unclear. We conducted a single-center, retrospective observational study to investigate the prevalence of persistent symptoms three months after discharge from the intensive care unit by checking the medical records. All patients received an early mobilization program. Four out of 13 patients (31%) had postintensive care syndrome. No patients had muscle weakness, and 11 patients (85%) returned to their previous work. However, psychiatric disorder, such as anxiety (23%) and posttraumatic stress disorder (15%), were observed. Eleven patients claimed persistent symptoms, including fatigue and numbness in the extremities. Our results suggest that the implementation of an early rehabilitation program plays some role in preventing muscle weakness and that decreasing psychiatric disorders should be a next target of patient care in the intensive care unit.

Small Finger Flexor Tendon Rerupture Occurred 4 Months after Tendon Graft Surgery: A Case Report

Case report: A right-handed man in his 60s sustained a subcutaneous rupture of the flexor tendon of the left small finger while playing golf. At one month after the injury, a bridge tendon graft was performed using the ipsilateral palmaris longus tendon. A dorsal extension block splint was fabricated the day after surgery, and early mobilization programs were initiated. Referring to previous reports, active finger flexion and extension exercises were performed under wearing the splint until 4-6 postoperative weeks, and full power grip was not allowed until 12 postoperative weeks. However, at 16 postoperative weeks, the moment he swung a golf club, the tendon rerupture occurred. Discussion: No studies have been reported on rerupture after 12 postoperative weeks. The author considered three factors of tendon rerupture. Firstly, it is weakening of the tendon due to steroid injection. Secondly, it is delayed tendon healing due to blood flow disturbance caused by synovial hyperplasia. Thirdly, it is the stress on the small finger flexor tendon of swinging a golf club. Conclusion: Therapists need to plan rehabilitation programs based on analysis of not only past reports but the patients’ background and lifestyle.

Barriers and enablers to the development and implementation of early mobility programs for children in the pediatric intensive care unit: a scoping review protocol.

The objective of this scoping review is to gather and map the current literature associated with barriers and enablers related to the development and implementation of an early mobility program in pediatric intensive care units. As care for critically ill patients has evolved, strategies to optimize patient outcomes and reduce the side effects of treatment have become a rising priority for clinicians, patients, and their families. Early mobilization of patients with critical illness is the only evidence-based intervention that decreases intensive care unit-acquired weakness; it may also minimize intensive care unit-acquired delirium. Early mobility in the pediatric setting has many obstacles, and routine uptake of early mobility practice has lagged. This review will consider literature related to the barriers and enablers to the development and/or implementation of early mobility programs in pediatric intensive care units. The review will target programs designed for children and youth from birth to 18 years who have been admitted to a pediatric intensive care unit. This scoping review will search six databases and several sources of unpublished/gray literature. Studies published in English and French will be included. The search will be restricted to publications after 1980. Data will be extracted using a tool developed by the reviewers. The data extracted will be presented in a tabular manner and highlight the key findings related to the objectives of this review.

Optimization of Early Mobilization Program for Patients With Acute Ischemic Stroke: An Orthogonal Design.

Background and purpose: Early mobilization is considered to have favorable outcomes for stroke patients, but there is currently a lack of specific data to guide this early mobilization, including the initiation time, intensity, frequency, and duration of each activity. Therefore, the optimal strategy for early mobilization is unclear. In this study, we investigated the best combination of different factors to achieve early mobilization, to develop the optimal program.Methods: We conducted an L9 (33) orthogonal experiment with a blinded follow-up assessment. Patients with ischemic stroke, admitted to a stroke unit within 24–72 h of its onset, were recruited. Eligible subjects were randomly assigned to one of nine different programs of early mobilization. The outcomes were assessed at baseline, discharge, and 1 and 3 months after discharge to observe the changes in various efficacy indicators and determine the main factors affecting outcome.Results: We analyzed 57 of 63 patients, after six were excluded for poor compliance, failure to cooperate with the study, or worsening of the disease. The initiation time, intensity, and frequency of mobilization were the main factors affecting outcome (all P < 0.05), and the duration of each activity was a secondary factor (P > 0.05). A comprehensive analysis of the various parameters showed that the optimal level of the early mobilization program was an initiation time: 24–48 h after stroke; intensity: bed and chair transfer, sitting out of bed, standing and walking or climbing stairs when mobility permitted; frequency: 2–3 times/day; duration of each mobilization: determined according to the actual situation of the patient.Conclusions: Early rehabilitation with high-intensity physical exercise at 24–48 h after the onset of stroke, 2–3 times/day, may benefit stroke patients. Applying the optimized program of early mobilization to stroke patients effectively alleviated their symptoms of neurological deficit, improved their capacity for self-care, restored their self-efficacy, improved their quality of life and social participation, and reduced post-stroke fatigue at 3 months.

Assessment of the Early Disabling Effects of Coronary Artery Bypass Graft Surgery Using Direct Measures of Physical Function.

Coronary artery bypass graft (CABG) surgery is an important treatment option in patients with coronary artery disease. Despite its beneficial effects, CABG surgery and its subsequent hospitalization may reduce physical functional capacity in patients, contributing to physical disability. Our objective was to assess the early disabling effects of CABG surgery and its subsequent hospitalization using direct measurements of physical function. Patients (n = 44) were assessed pre-surgery and at hospital discharge for physical function using the Short Physical Performance Battery (SPPB) and self-reported physical and mental health by questionnaire. The total SPPB score (P < .001) and all of its components (P < .01-.001) decreased markedly following CABG surgery and hospitalization, with greater reductions in total SPPB score (P < .05) and gait speed (P < .01) in patients with higher body mass index. While CABG surgery and hospitalization reduced patient-reported physical function, changes in these indices largely did not correlate with changes in SPPB outcomes. Our results show the early disabling effects of CABG surgery and hospitalization on directly measured physical function, and that patients with higher body mass index had greater reductions. In addition, our results underscore the need to perform direct measurements of physical function to describe reductions in physiological functional capacity. These findings suggest the need for inpatient rehabilitation or early mobility programs to address this decline in physical function.

Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit.

IntroductionChildren with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population.MethodsWe describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission.ResultsBetween January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.ConclusionsOur experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.

P0674 / #761: SPARKING PAEDIATRIC ACTIVITY IN CRITICAL CARE EDINBURGH (S.P.A.C.E): HOW STAFF PERCEPTIONS AND CURRENT PRACTICE SHAPE THE DEVELOPMENT OF A NOVEL EARLY MOBILISATION PROGRAMME

Aims & Objectives: We aim to use a data-driven approach to develop and implement a novel early mobilisation programme in Edinburgh. Methods: A single-centred mixed methodology multi-disciplinary (MDT) prospective study was conducted over a 12-week study period. Using a pre-designed survey, staff knowledge and their perceived barriers on early mobilisation were determined. Physiotherapists’, nursing and medical notes were reviewed to extract data on existing mobilisation practice using a pre-designed data-collection-form. The S.P.A.C.E (Sparking Paediatric Activity in Critical Care Edinburgh) MDT steering group used these findings to develop the S.P.A.C.E. protocols with safety criteria and family goals sheets. A standardised education package was developed to implement this novel mobilisation programme. Results: The mean duration to first mobilisation for invasively-ventilated (n = 48) and non-ventilated patients (n=42) were 5.6 and 3.8 days respectively, which did not meet the current recommendations. Staff had good general understanding of early mobilisation but limited understanding of specific approaches. Staff’s perceived barriers to early mobilisation included staffing time constraints and safety concerns. A data-driven S.P.A.C.E. early mobilisation MDT protocol with defined safety criteria was successfully developed for implementation. Conclusions: Engagement of front-line MDT staff on early mobilisation and a data-driven approach successfully developed and implemented a novel early mobilisation programme (S.P.A.C.E.) on our unit. An audit of practice to look at the impact of S.P.A.C.E is planned over the next few months with a follow up repeat survey to see if perceptions and concerns have changed.

Safety First: An Ambulation Protocol for Patients With Pulmonary Artery Catheters.

Patients with indwelling pulmonary artery catheters have historically been excluded from participating in early mobility programs because of the concern for catheter-related complications. However, this practice conflicts with the benefits accrued from early mobilization. The purposes of this quality improvement project were to develop and implement a standardized ambulation protocol for patients with a pulmonary artery catheter in a cardiac surgery intensive care unit and to assess and support safe ambulation practices while preventing adverse events in patients with pulmonary artery catheters. From October 2016 through October 2017, this single-center quality improvement project developed and analyzed the implementation of a safe patient ambulation protocol in the cardiac surgery intensive care unit. Frontline nursing staff and the interdisciplinary team were educated on a standardized protocol that facilitated patient ambulation. Data analyzed included distance of ambulation, catheter migration, presence of cardiac dysrhythmias, and adverse events during ambulation. During this 1-year project, 41 patients participated in 94 walks for a total distance of 13 676.38 m. There were no reported episodes of cardiac dysrhythmia, accidental occlusion of the pulmonary artery, catheter migration, or pulmonary artery rupture related to ambulation with a pulmonary artery catheter. The use of a standardized ambulation protocol can successfully result in safe mobilization of patients with indwelling pulmonary artery catheters.

Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit.

EMP was implemented in our PICU in May 2017. The percentage of appropriate physical and occupational therapist consults were determined. We also evaluated the activity levels received by the patient and the levels for which they qualified based on their medical condition. Failure Modes and Effects Analysis (FMEA) was performed to identify potential complications related to the mobilization of critically ill children. We created 4 simulation scenarios based on FMEA prioritized results. After the implementation of EMP, appropriate physical and occupational therapist consults significantly increased (P < 0.0001). However, most patients still failed to receive the optimal level of activity recommended by protocol. This failure was partly due to concern for safety events during mobilization. FMEA identified vital sign changes [Risk Priority Number (RPN) 97.8], staff injury (RPN 64), and pain/anxiety (RPN 60.5) as potential safety events. We performed various in-situ simulation sessions based on these potential events. In post-simulation evaluations, 100% of participants agreed that the simulation experience would improve their performance in the actual clinical setting. Feedback from simulations led to the development of an EM patient safety checklist and clinical pathway. We describe a novel technique of using FMEA to develop scenarios that simulate potential adverse events to optimize safe EM in PICU. An EM checklist and pathway can guide in the implementation of safe EMP.

Early Mobilization Following Gastro-Intestinal and Gynecological Cancer Surgeries

Context: There has been an increase in the incidence of gastrointestinal and gynaecological cancers and advancement in surgeries has made surgical treatment more for these participants more feasible. Aim: To evaluate the effect of structured early mobilization programs in postoperative gastrointestinal and gynaecological cancer patients on 30second chair stand test, functional assessment of cancer therapy-general (FACT-G) and length of hospital stay. Settings and Design: This was a clinical trial conducted at tertiary care hospital on gastrointestinal and gynecological cancer patients. Materials and Methods: Participants diagnosed with gastro-intestinal (n = 23) and gynaecological (n = 17) cancers who underwent surgery were included in the study. Lower extremity strength was assessed using 30 s chair stand test and the quality of life (QOL) was assessed using the FACT-G Scale. Length of hospital stay was noted from the postoperative day 1 till the day of discharge. Statistical Analysis Used: Wilcoxon Test and Spearman's rank correlation coefficient test were used for analysis. Results: Early mobilization program in postoperative gastro-intestinal and gynecological surgery participants showed improvement in the lower extremity strength in terms of 30 s chair stand test (P = 0.001). Moreover, improvements were also observed in the components of QOL viz., physical (P = 0.004), social (P = 0.041) and functional (P = 0.004) components. Conclusion: The study findings demonstrate improvement in lower extremity strength in terms of 30 s chair stand test and QOL according to FACT-G.

Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up!

To identify staff-reported factors and perceptions that influenced implementation and sustainability of an early mobilization program (PICU Up!) in the PICU. A qualitative study using semistructured phone interviews to characterize interprofessional staff perspectives of the PICU Up! program. Following data saturation, thematic analysis was performed on interview transcripts. Tertiary-care PICU in the Johns Hopkins Hospital, Baltimore, MD. Interprofessional PICU staff. None. Fifty-two staff members involved in PICU mobilization across multiple disciplines were interviewed. Three constructs emerged that reflected the different stages of PICU Up! program execution: 1) factors influencing the implementation process, 2) staff perceptions of PICU Up!, and 3) improvements in program integration. Themes were developed within these constructs, addressing facilitators for PICU Up! implementation, cultural changes for unitwide integration, positive impressions toward early mobility, barriers to program sustainability, and refinements for more robust staff and family engagement. Three years after implementation, PICU Up! remains well-received by staff, positively influencing role satisfaction and PICU team dynamics. Furthermore, patients and family members are perceived to be enthusiastic about mobility efforts, driving staff support. Through an ongoing focus on stakeholder buy-in, interprofessional engagement, and bundled care to promote mobility, the program has become part of the culture in the Johns Hopkins Hospital PICU. However, several barriers remain that prevent consistent execution of early mobility, including challenges with resource management, sedation decisions, and patient heterogeneity. Characterizing these staff perceptions can facilitate the development of solutions that use institutional strengths to grow and sustain PICU mobility initiatives.

1055: Impact of an Early Mobility Program in the Hematologic Oncologic PICU Setting

Curry, Amanda1; Brown, Amanda1; Williams, Sarah1; Schwartzberg, Sarah1; Parkhurst, Lucy1; Trone, Deni2; Butrum-Sullivan, Jacqueline1; Pettit, Ken1; Ghafoor, Saad3 Author Information

1121: Move 2 Improve: The Introduction of an Early Mobility Program in a Pediatric Intensive Care Unit

1121: Move 2 Improve: The Introduction of an Early Mobility Program in a Pediatric Intensive Care Unit