Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme

Abstract

Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient’s physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard ‘run chart rules’ to detect changes in outcomes over time and Welch’s t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.

Factors Determining the Functional State of Cardiac Surgery Patients with Complicated Postoperative Period

“…However, recent meta-analyses have obtained conflicting data: early mobilization improved exercise tolerance in patients after cardiac surgery in the work by Kanejima Y et al [ 10 ] but had no effect on the length of stay in the intensive care unit or the total length of hospital stay in a study by Chen and colleagues [ 11 ]. This indicates the continuing relevance of research in this area [ 12 , 13 ], especially in the case of difficulties with the implementation of generally accepted rehabilitation programs. Accordingly, the purpose of this work was to study factors associated with the distance reached during the six-minute walk test by cardiac surgery patients with a complicated postoperative period upon discharge from the hospital.…”

Relationship between Perme ICU Mobility Score and length of stay in patients after cardiac surgery

“…Due to the reason that this is the only instrument to consider in assessment, potential barriers to mobility may affect patients' performance in mobility activities 14,33 . In the context of cardiovascular surgery, pain in the sternotomy area and chest tube site was one of the main obstacles to implementing mobility activities as part of routine clinical practice 34 . The low mobility status observed on the first postoperative day can be associated with barriers (i.e., pain, catheters, drains, and tubes) after surgery rather than a functional decline, considering the patient's previous function before surgery.…”

“…The time at which ambulation is first initiated in postoperative patients directly affects outcomes, which may enhance functional independence 34 . The findings of our study demonstrated that patients with better mobility status on the second (only CABG alone) and third postoperative days (three types of intervention) presented a shorter ICU stay.…”

PH Professional Network: The Role of the Advanced Practice Nurse With Patients Undergoing Pulmonary Thromboendarterectomy and Balloon Pulmonary Angioplasty for CTEPH

“…15 Additional management considerations include right ventricular support with inotropes and early mobilization and ambulation to improve patient functionality and reduce the risk of postoperative deep vein thrombosis, lung infection, and pleural effusion. 16 The length of stay for a PTE patient at our institution is approximately 5 days. Patients are discharged on warfarin anticoagulation with a goal international normalized ratio (INR) between 2 to 3.…”

“…BPA is an option available to CTEPH patients who are not eligible for surgical intervention with PTE for a variety of reasons including certain comorbidities, persistent symptoms despite optimized surgical or medical therapy, patient request for a less invasive procedure, or for residual PH post-PTE. 1,2,4,16,[19][20][21] The survival rate for nonsurgical PTE candidates has significantly improved since the availability of BPA as well as newer medical therapies. 22 Taniguchi and collegues looked at the survival rates of nonoperative CTEPH patients that underwent BPA and found 1-year and 3-year survival rates of 98.8% and 92.9%, respectively.…”