Progressive Mobility Protocol Reduces Venous Thromboembolism Rate in Trauma Intensive Care Patients: A Quality Improvement Project

Abstract

The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program.

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

“…Mobility is also an important component for VTE prevention, as early mobility leads to a reduction in VTE. 37 A mobility protocol is safe in trauma patients and may reduce patient deconditioning besides decreasing the rate of VTE. 37 Prolonged maintenance of spinal precautions is associated with an increased DVT rate and should be avoided to allow early mobility.…”

Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers

“…Ultimately, we found that most of the guideline implementation reports we identified did use improvement terminology in the title and abstract to characterize their studies. Some such studies used an explicit statement that implementation was done as a quality or performance improvement program 57,61 . Still, one-fifth of included studies did not use sufficient improvement terminology in self-labeling despite their examinations of improvements in clinical effectiveness and outcomes associated with guideline implementation.…”

Trauma-induced pulmonary thromboembolism: What's update?

“… 94 It was found that a mobility protocol is safe in trauma patients and may reduce the rate of traumatic VTE. 95 On the contrary, prolonged maintenance of spinal precautions (>72 h) is associated with an increased immobility-associated DVT rate and physicians should focus on prompt, definitive care and early mobilization. 96 …”