The Effects of Early Mobilization on Patients Requiring Extended Mechanical Ventilation Across Multiple ICUs

Escalon, Miguel X.; Lichtenstein, Ann H.; Posner, Elliot; Spielman, Lisa; Delgado, Andrew; Kolakowsky-Hayner, Stephanie A.

OBJECTIVES: 1) To successfully implement early mobilization of individuals with prolonged mechanical ventilation in multiple ICUs at a tertiary care hospital and 2) to reduce length of stay and improve quality of care to individuals in the ICUs. DESIGN: Comparative effectiveness cohort study based on a quality improvement project. SETTING: Five ICUs at a tertiary care hospital. PATIENTS: A total of 541 mechanically ventilated patients over a 2-year period (2014–2015): 280 and 261, respectively. Age ranged from 19 to 94 years (mean, 63.84; sd, 14.96). INTERVENTIONS: A hospital-based initiative spurred development of a multidisciplinary team, tasked with establishing early mobilization in ICUs. MEASUREMENTS AND MAIN RESULTS: Early mobilization in the ICUs was evaluated by the number of physical therapy consults, length of stay, individual treatment sessions utilizing functional outcomes, and follow-up visits. Implementation of an early mobilization protocol across all ICUs led to a significant increase in the number of physical therapy consults, a significant decrease in ICU and overall lengths of stay, significantly shorter days to implement physical therapy, and a significantly higher physical therapy follow-up rate. CONCLUSIONS: Mobilizing individuals in an intensive care setting decreases length of stay and hospital costs. With an interdisciplinary team to plan, implement, and evaluate stages of the program, a successful early mobilization program can be implemented across all ICUs simultaneously and affect change in patients who will require prolonged mechanical ventilation.