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. 2022 Oct 13;12(1):17206.
doi: 10.1038/s41598-022-21227-y.

Effectiveness of a quality improvement strategy with implementation of a specific visual tool to promote ICU early mobilization

Patricia Nery de Souza  1 , Jessica Borges Kroth  2 , Amanda Dos Santos Ligero  2 , Juliana Mesti Mendes  2 , Ana Lígia Vasconcelos Maida  2 , Laerte Pastore  2 , Wellington Pereira Yamaguti  2
Affiliations

Effectiveness of a quality improvement strategy with implementation of a specific visual tool to promote ICU early mobilization

Patricia Nery de Souza et al. Sci Rep. .

Abstract

Early progressive mobilization is a safe strategy in the intensive care unit (ICU), however, it is still considered challenging by the inherent barriers and poor adherence to early mobilization protocol. The aim of this study was to evaluate the effectiveness of a quality improvement (QI) multifaceted strategy with implementation of a specific visual tool, the "mobility clock", in reducing non-compliance with the institutional early mobilization (EM) protocol in adult ICUs. A single-center QI with a retrospective before-after comparison study was conducted using data from medical records and hospital electronic databases. Patients from different periods presented similar baseline characteristics. After the QI strategy, a decline in "non-compliance" with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). The proportion of patients walking was significantly higher (49.44% vs. 29.21%, p < 0.006) and the ICU readmission rate was lower in the "after" period (2.25% vs. 11.24%; p = 0.017). The multifaceted strategy specifically designed considering institutional barriers was effective to increase out of bed mobilization, to reduce the "non-compliance" rate with the protocol and to achieve a higher level of mobility in adult ICUs of a tertiary hospital.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
The mobility clock monitors the level of mobility in the intensive care units of Hospital Sírio-Libanês and is based on the ICU mobility scale. It presents ten mobility milestones (the higher the score, the higher the mobility level achieved by the patient). One of the hands of the clock represents the mobility level planned by the multidisciplinary team for the patient during the shift (goal), and the other, represents what was achieved. In the example above, the objective elaborated by the team was to “march on spot” (level 6) and the milestone achieved was to “sit on the edge of bed” (level 3). Thus, the objective was not reached because the level of mobility achieved was lower than planned.
Figure 3
Figure 3
Study sample flowchart.
Figure 4
Figure 4
Institutional protocol “non-compliance” rate.
Figure 5
Figure 5
Proportion of highest mobility landmark achieved.
See this image and copyright information in PMC

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