Introducing early and structured rehabilitation in critical care: A quality improvement project. (August 2019)

• Record Type: Journal Article
• Authors: McWilliams, David; Snelson, Catherine; Goddard, Hannah; Attwood, Ben
• Is Part Of: Intensive and critical care nursing. Volume 53(2019)
• Page Start: 79
• Page End: 83
• Publication Date: 2019-08
• Subjects: Critical care -- ICU -- Implementation -- Physiotherapy -- Quality improvement -- Rehabilitation; Intensive care nursing -- Periodicals; Critical Illness -- nursing -- Periodicals; Intensive Care -- Periodicals; Nursing Care -- Periodicals; Intensive care nursing; Periodicals; Electronic journals; 616.028
• DOI: 10.1016/j.iccn.2019.04.006
• Languages: English
• ISSNs: 0964-3397

Abstract

Abstract: Objectives: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. Design: Fifteen-month prospective before/after quality improvement project. Setting: Seven-bed mixed dependency critical care unit. Participants: 209 patients admitted to critical care for ≥4 days. Intervention: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. Main outcome measure: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. Results: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). Conclusion: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.