Quality improvement intervention to stimulate early mobilization of critically ill children

Background Immobility during hospital stay is associated with muscle weakness, delirium, and delayed neurocognitive recovery. Early mobilization of critically ill adults improves their physical functioning and shortens the duration of mechanical ventilation. However, comparable research in children is lacking. Aims To determine the effects of the implementation of an early mobilization (EM) program on mobility activities for critically ill children and to explore barriers and facilitators and clinical outcomes before and after implementation. Study design A prospective single-centre before-and-after study. Methods This study was conducted in a PICU of a large tertiary hospital. Children aged from 3 months to 18 years, with an expected stay of >= 3 days were eligible to participate. In the before phase, participants received usual care; in the after phase we implemented a multicomponent, multidisciplinary EM protocol. The primary outcome was a change in the process outcome mobilization activities. Secondary outcomes were PICU staff opinions on mobilization (survey), safety, process measures, involvement of parents and physical therapist, and clinical outcomes (sedative use and prevalence of delirium). Results A total of 113 children were included; 55 before and 58 after, with a median age of 31 months (IQR: 10-103) and 35 months (IQR: 7-152), respectively. The number of mobilization activities (per patient per day) had significantly increased from 5 (IQR: 2-7) to 6 (IQR: 4-8) (U = 272185.0; p < .001). PT consultations for mobilization had significantly increased from 23.6% (13/55) to 46.5% (27/58) (X-2 = 6.48; p = .011). In both phases, no mobilization-related adverse events were documented. The survey showed that PICU staff found EM of critically ill children useful and feasible. In the after phase, PICU staff rated the perceived benefit of the support of the physical therapist during mobilization activities significantly higher than in the before phase (X-2 = 34.80; p < .001). Conclusions Implementation of a structured EM program for critically ill children is feasible and safe. Relevance to clinical practice It is suggested to start the implementation of a structed EM program with the idendentification of local barriers and facilitators by an interdisciplinary PICU team. Further, an increased presence of physiotherapists on the PICU would improve mobilisation levels, and facilitate mobilisation in critically ill children. Also, they can support and advice PICU nurses and parents in mobilising children.

Automated summary

Implementation of an early mobilization program for critically ill children is feasible and beneficial. ICU staff has positive opinions on the program and it improves mobilization activities and involvement of physical therapists.