Enhancing early mobilization in critically ill patients through multidisciplinary rounds: A process-focused observational study

Abstract

Backgrounds: Early mobilization (EM) is vital for critically ill patients, yet various barriers hinder its implementation in daily critical care practice. This study aimed to explore the impact of multidisciplinary rounds (MDR) on the initiation of EM.

Methods: We conducted a retrospective, process-focused observational study in the medical/surgical intensive care unit (ICU) of a tertiary university medical center in Tokyo, Japan, including 301 patients who received physical therapy (PT) during their ICU stay. MDR implementation commenced in October 2016, followed by a year-long initiative to enhance awareness about the importance of EM. Patients admitted between April 2015 and September 2016 were categorized into the pre-MDR group (Phase 1, n = 110), while those admitted from October 2017 to March 2019 formed the post-MDR group (Phase 2, n = 191).

Results: EM practice was significantly increased in Phase 2, compared to Phase 1 (39.8% vs. 20.9%; p = 0.001), particularly among mechanically ventilated patients (33.8% vs. 9.3%; p < 0.001). The median time from ICU admission to PT initiation was significantly reduced in Phase 2 (3.0 vs. 6.0 days, p < 0.001). Additionally, PT consultations significantly increased from 9.2% to 16.5% (χ² = 27.75, p < 0.001). MDR was associated with an 84% higher likelihood of initiating EM (adjusted relative risk 1.84, 95% CI 1.30-2.61).

Conclusions: MDR played a pivotal role in enhancing the initiation of EM for ICU patients, highlighting its significance in overcoming barriers to EM.

Keywords: Early mobilization; Intensive care unit; Multidisciplinary rounds; Quality improvement.