Improving Outcomes for Critically Ill Cardiovascular Patients Through Increased Physical Therapy Staffing

Objective: To examine the effect of increasing physical therapy (PT) staff in a cardiovascular intensive care unit (CVICU) on temporal measures of PT interventions and on outcomes important to patients and hospitals. Design: Retrospective pre/post subgroup analysis from a quality improvement initiative. Setting: Academic medical center. Participants: Cardiovascular patients in either a baseline (N=52) or quality improvement period (N= 62) with a CVICU length of stay (LOS) >= 7 days and use of any one of the following: mechanical ventilation, continuous renal replacement therapy, or mechanical circulatory support. Interventions: The 6-month quality improvement initiative increased CVICU-dedicated PT staff from 2 to 4. Main Outcome Measures: Changes in physical therapy delivery were examined using the frequency and daily duration of PT intervention. Post-CVICU LOS was the primary outcome. CVICU LOS, mobility change, and discharge level of care were secondary outcomes. A secondary analysis of hospital survivors was also conducted. Results: Compared to those in the baseline period, cardiovascular patients in the quality improvement period participated in PT for an additional 9.6 minutes (95% confidence interval [CI]: 1.9, 17.2) per day for all patients and 15.1 minutes (95% CI: 7.6, 22.6) for survivors. Post-CVICU LOS decreased 2.2 (95% CI: -6.0, 1.0) days for all patients and 2.6 days (95% CI: -5.3, 0.0) for survivors. CVICU LOS decreased 3.6 days (95% CI: -6.4, -0.8) for all patients and 3.1 days (95% CI: -6.4, -0.9) for survivors. Differences in mobility change and discharge level of care were not significant. Conclusions: Additional CVICU-dedicated PT staff was associated with increased PT treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors. (C) 2018 by the American Congress of Rehabilitation Medicine