The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project

Falkenstein, Beth A; Skalkowski, Chelsea K; Lodise, Kathleen D; Moore, Marian E.; Olkowski, Brian F.; Rojavin, Yuri

doi:10.1097/jtn.0000000000000479

Cited by 18 publications

(23 citation statements)

References 28 publications

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“…If diaphragm ultrasound can assist the clinician in extubating a patient sooner and reduce the ICU length of stay, this can result in considerable cost savings. A study evaluating the impact of an early mobility program in a trauma ICU suggested that a reduction in ICU length of stay of 1.31 days resulted in a cost savings of $8,239 per patient [29].…”

Section: Discussionmentioning

confidence: 99%

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

McCool

Oyiengo

Koo

2020

Lung

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Purpose Prediction of optimal timing for extubation of mechanically ventilated patients is challenging. Ultrasound measures of diaphragm thickness or diaphragm dome excursion have been used to aid in predicting extubation success or failure. The aim of this study was to determine if incorporating results of diaphragm ultrasound into usual ICU care would shorten the time to extubation. Methods We performed a prospective, randomized, controlled study at three Brown University teaching hospitals. Included subjects underwent block randomization to either usual care (Control) or usual care enhanced with ultrasound measurements of the diaphragm (Intervention). The primary outcome was the time to extubation after ultrasound, and the secondary outcome was the total days on the ventilator. Only intensivists in the Intervention group would have the ultrasound information on the likelihood of successful extubation available to incorporate with traditional clinical and physiologic measures to determine the timing of extubation. Results A total of 32 subjects were studied; 15 were randomized into the Control group and 17 into the Intervention group. The time from ultrasound to extubation was significantly reduced in the Intervention group compared to the Control group in patients with a ∆tdi% ≥ 30% (4.8 ± 8.4 vs 35.0 ± 41.0 h, p = 0.04). The time from ultrasound to extubation was shorter in subjects with a normally functioning diaphragm (∆tdi% ≥ 30%) compared to those with diaphragm dysfunction (∆tdi% < 30%) (23.2 ± 35.2 vs 57.3 ± 52.0 h p = 0.046). When combining the Intervention and Control groups, a value of ∆tdi% ≥ 30% for extubation success at 24 h provided a sensitivity, specificity, PPV and NPV of 90.9%, 86.7%, 90.9%, and 86.7%, respectively. Conclusions Diaphragm ultrasound evaluation of ∆tdi% aids in reducing time to extubation.

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Section: Discussionmentioning

confidence: 99%

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

McCool

Oyiengo

Koo

2020

Lung

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“…Inpatient mobility initiatives in their various forms are effective interventions for decreasing length of hospital stay, lessening morbidity, and improving both strength and physical function [21][22][23][24][25][26][27][28][29][30][31]. However, many of these initiatives are limited in scope or address the actions of only one specific group of unit practitioners.…”

Section: Discussionmentioning

confidence: 99%

“…Early mobilization has been demonstrated to be an effective therapeutic intervention for improving outcomes among both ICU and general medicine adult patients [21][22][23][24][25][26][27][28][29][30][31]. Prior studies consistently demonstrate decreased use of hospital resources as well as improvement in length of hospital stay, especially among patients with myocardial infarctions, total knee replacements, hip fractures, and community acquired pneumonia [24,[32][33][34][35][36][37][38][39].…”

Section: Introductionmentioning

confidence: 99%

A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients

Bergbower

Herbst

Cheng

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Inpatient early mobility initiatives are effective therapeutic interventions for improving patient outcomes and decreasing use of hospital resources among adult ICU and general medicine patients. To establish and demonstrate guidelines for early patient ambulation, we developed and implemented a novel multidisciplinary mobility bundle utilizing the JH-HLM (Johns Hopkins Highest Level of Mobility) scale for mobility classification, on a single adult general medicine unit of a community hospital. Our results show that patients admitted to the unit after implementation of the mobility bundle had improved mobility scores, reduced rates of 30-day hospital readmission, and a shortened length of hospital stay. This study emphasizes the importance of measuring mobility using a systematic method, easing workflow among unit practitioners, and allowing mobility initiatives to be jointly driven by nursing, physical therapy, and physicians.

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“…Studies have shown the economic and clinical impact of early mobility programs in trauma intensive care units and their impact in the reduction of patient care costs. 16 Given the success of enhanced recovery after surgery (ERAS) programs at reducing cost for a plethora of surgical procedures, [17][18][19] a similar approach can be explored for enhanced recovery of trauma patients. Clearly, the diversity of trauma patients does not permit a single unified ERAS protocol.…”

Section: Open Accessmentioning

confidence: 99%

Financial implications of trauma patients at a Canadian level 1 trauma center: a retrospective cohort study

Fontebasso

Figueira

Thavorn

et al. 2020

Trauma Surg Acute Care Open

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BackgroundTrauma is a cause of significant morbidity and mortality globally, and patients with major trauma require specialized settings for multidisciplinary care. We sought to enumerate the variability of costs of caring for patients at a Canadian level 1 trauma center.MethodsA retrospective analysis of all adult patients admitted to The Ottawa Hospital trauma service between June 2013 and June 2018 was conducted. Hospital costs and clinical data were collected. Descriptive statistics and multivariable regression analysis using generalized linear model were performed to assess cost variation with patient characteristics. Quintile-based analyses were used to characterize patients in different cost categories. Hospital costs were reported in 2018 Canadian dollars.ResultsA total of 2381 admissions were identified in the 5-year cohort. The mean age of patients was 50.2 years, the mean Injury Severity Score (ISS) was 18.7, the mean Charlson Comorbidity Index (CCI) score was 0.35, and the median total cost was $10 048.54. ISS and CCI score were associated with higher costs (ISS >15; p<0.0001). The most expensive mechanisms of injury (MOIs) were those involving heavy machinery (median total cost $24 074.38), pedestrians involved in road traffic collisions ($20 965.45), patients in motor vehicle collisions ($17 621.01) and motorcycle collisions ($16 220.89), and acts of self-injury ($13 903.69). Patients who experienced in-hospital adverse events were associated with higher costs (p<0.0001). Our multivariable regression analysis showed variation in costs related to male gender, penetrating/violent MOI, ISS, adverse hospital events, CCI score, urgent admission status, hospital 1-year mortality risk score, and alternate level of care designation (p<0.05). Quintile-based analyses demonstrated clinically significant differences between the highest and lowest cost groups.DiscussionMajor trauma was associated with high hospital costs. Modifiable and non-modifiable patient factors were shown to correlate with differing total hospital costs. These findings can aid in the development of funding strategies and resource allocation for this complex patient population.Level of evidenceLevel III evidence for economic and value-based evaluations.

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The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project

Cited by 18 publications

References 28 publications

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

The Utility of Diaphragm Ultrasound in Reducing Time to Extubation

A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients

Financial implications of trauma patients at a Canadian level 1 trauma center: a retrospective cohort study

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