Introducing early and structured rehabilitation in critical care: a quality improvement project
Snelson, Catherine Goddard, Hannah
Snelson, Catherine
Goddard, Hannah
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Affiliation
University Hospitals Birmingham NHS Foundation Trust; South Warwickshire University NHS Foundation Trust
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Publication date
2019-08
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Abstract
Objectives: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation.
Design: Fifteen-month prospective before/after quality improvement project.
Setting: Seven-bed mixed dependency critical care unit.
Participants: 209 patients admitted to critical care for ≥4 days.
Intervention: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care.
Main outcome measure: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care.
Results: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019).
Conclusion: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.
Keywords: Critical care; ICU; Implementation; Physiotherapy; Quality improvement; Rehabilitation.
Citation
McWilliams D, Snelson C, Goddard H, Attwood B. Introducing early and structured rehabilitation in critical care: A quality improvement project. Intensive Crit Care Nurs. 2019 Aug;53:79-83. doi: 10.1016/j.iccn.2019.04.006. Epub 2019 May 2.
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Article