Introducing early and structured rehabilitation in critical care: a quality improvement project

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.