Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative

Abstract

Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients.

Methods: We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing.

Results: All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05).

Conclusions: This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.

Fig. 1.

Key driver diagram for early mobilization in the pediatric intensive care unit. Items in gray were deemed out of scope of the project.

Fig. 2.

Project timeline.

Fig. 3.

Pediatric intensive care unit algorithm for early mobilization, including contraindications, precautions, and signs of intolerance.

Fig. 4.

Control chart of primary measure: percent of patients mobilized within the allotted time frame. Allotted time frame defined as 18 hours for mechanically ventilated patients and 48 hours for nonmechanically ventilated patients.