Background Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. Methods A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. Results The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. Conclusions Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.
Purpose: This study's primary objective is to determine the current use of outcome measures (OMs) by physical therapists practicing in acute care settings. Secondarily, this study aims to establish whether physical therapists support the development of a core OM set for use in acute care settings. Methods: An investigator-developed online survey (Qualtrics) was distributed to acute care physical therapy stakeholders, including practicing clinicians, educators, and administrators. The survey contained 4 sections with 28 questions: (1) acute care physical therapy practice patterns; (2) use of OMs in practice; (3) the development of a core OM set; and (4) demographic, education, and experience in the physical therapy profession. Descriptive statistics were used to assess response frequency and rationale for the use of specific OMs. Results: A convenience sample of 170 acute physical therapy stakeholders completed the survey. Respondents represented 38 states, with most respondents (n = 153; 90%) practicing in one or more acute care specialty areas. The majority of respondents (n = 145; 83%) reported using an OM more than 50% of the time in their practice. Physical function was the main construct (n = 163; 96%) respondents assessed with an OM. Acute care physical therapists primarily used OMs to track response to interventions (n = 134; 79%) and develop a care plan (n = 91; 54%). Length of time required to complete an OM and its clinical utility were the most common rationales for selecting an OM (n = 150, 88%; n = 147, 86%, respectively). Strong support was found for developing a core OM set for acute physical therapist practice (n = 147; 86%). The preferred methods for the organization of a core OM set, in rank order, were by diagnosis, International Classification of Functioning, Disability, and Health (ICF) framework, domains of health, and settings/location. Conclusion: Most physical therapists participating in this study of practice in acute care reported using OMs in their daily practice. This survey confirms the desire to develop a core OM set with high clinical utility for use in acute care settings.
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