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Abstract

There was considerable overlap of all other terms across multiple SOIs. Conclusions: With few exceptions, the language that ICU clinicians commonly use to describe patients poorly differentiates them according to SOI. Consequently, care teams risk misunderstanding what is meant when these terms are used and leading to possible medical errors.Learning Objectives: The Surgical/Trauma ICU/PCU (STICU) multidisciplinary team has worked to reduce sedation and delirium in all our patients by utilizing an evidence-based resource: ABCDE bundle (Awakening and Breathing Trial Coordination, Delirium Assessment and Management, Early Exercise/Progressive Mobility). This quality project focused on the "E" component of the bundle. Progressively mobilizing ICU patients, even in the early phases of illness, prevents ICU acquired weakness and decreases delirium, ventilator-associated pneumonia, and length of stay. Baseline audits revealed limited use of our standard adult ICU early mobility algorithm and delays in moving patients along the mobility continuum. Methods: Our team tailored our standard mobility algorithm to the STICU population. Safety screening criteria were used to determine patient readiness for mobility and the Richmond Agitation/Sedation Score guided specific interventions. The patient's actual mobility levels were tracked with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM). Multidisciplinary staff education was instituted using staff meetings, 1-1 conversations, and flyers. "Move" signs on the STICU walls every 20 feet served as visual reinforcement. Results: Fewer patients (5.6% to 4.9%) were moved to lateral transfer chairs (JH-HLM Level 2). There was a modest increase of total STICU patient (27% to 30%), who were dangled, stood or pivoted to a chair (JH-HLM Levels 3-5) although the largest increase was noted in the PCU population (18.8% to 28.5%). While the cumulative percentage of STICU patients walking any distance pre to post-intervention was similar, there was an increase in the distances walked (JH-HLM Levels 6-8) in both ICU and PCU patients (>250 feet) ICU: 3.4% to 37.2%, PCU: 18.8% to 34.8%. Conclusions: Our multidisciplinary team successfully shifted unit culture regarding the approach to mobility, and modified our standard ICU mobility algorithm to meet the unique needs of STICU patients. Incorporating early mobility takes teamwork, ongoing communication, persistence, and accountability to address mobility needs of every patient.