PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children*

Abstract

Objective To determine the safety and feasibility of an early mobilization program in a pediatric intensive care unit (PICU). Design Observational, pre-post design. Setting PICU in a tertiary academic hospital in the United States. Patients Critically ill pediatric patients admitted to the PICU. Intervention This quality improvement project involved a usual-care baseline phase, followed by a quality improvement phase that implemented a multicomponent, interdisciplinary, and tiered activity plan to promote early mobilization of critically ill children. Measurements and Main Results Data was collected and analyzed from July to August 2014 (pre-implementation phase) and July to August 2015 (post-implementation). The study sample included 200 children aged 1 day through 17 years who were admitted to the PICU and had a length of stay of at least 3 days. PICU Up! implementation led to an increase in occupational therapy consultations (44% vs 59%; p=0.034) and physical therapy consultations (54% vs. 66%; p=0.08) by PICU day 3. The median number of mobilizations per patient by PICU Day 3 increased from 3 to 6 (p<0.001). More children engaged in mobilization activities after the PICU Up! intervention by PICU day 3, including active bed positioning (p<0.001) and ambulation (p=0.04). No adverse events occurred as a result of early mobilization activities. The most commonly reported barriers to early mobilization after PICU Up! implementation was availability of appropriate equipment. The program was positively received by PICU staff. Conclusions Implementation of a structured and stratified early mobilization program in the PICU was feasible and resulted in no adverse events. PICU Up! increased physical therapy and occupational therapy involvement in the children’s care and increased early mobilization activities, including ambulation. A bundled intervention to create a healing environment in the PICU with structured activity may have benefits for short- and long-term outcomes of critically ill children.

Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness

“…Prior work examining pediatric rehabilitation within the PICU has focused primarily on understanding trends in service use 1,35 and exploring barriers to and safety of implementing rehabilitation services within the PICU. 36 These studies found rehabilitation services are feasible within the PICU, and approximately 50% of the PICU population receives rehabilitation services. To our knowledge, this is the first study to examine the association between receiving early rehabilitation services and caregiver stress in any population.…”

Physical and occupational therapy utilization in a pediatric intensive care unit

“…Mobility programs expedite return to activities of daily living and reduce lengths of stay and cost, without affecting safety events, but they have not been adequately prospectively studied in children 10,25,26 . A single center quality initiative has shown that mobility interventions for critically ill children can be increased without negative safety effects 19 .…”

“…Small pediatric studies highlight the uncertainties and challenges of incorporating rehabilitative services into clinical PICU practice while other centers are translating data from adult studies into pediatric practice 13–15 . There is a vital need for prospective interventional trials in critically ill children to inform guidelines for the optimal consultation for physical (PT) and occupational therapy (OT) and other rehabilitative and supportive services to demonstrate efficacy in improving outcome 13,15–19 .…”

Brighter Days May Be Ahead: Continuous Measurement of Pediatric Intensive Care Unit Light and Sound

“…Recently, pediatric intensive care early mobility and rehabilitation initiatives such as "PICU Up!" also show promise for improving functional survival (22). Interestingly, the majority of these types of studies have not reported baseline light and sound characteristics, nor have they demonstrated whether bundle or mobility interventions inherently alter environmental characteristics, and if this aspect is uniquely beneficial.…”