Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative

Abstract

Introduction: Critical illness results in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children. Methods: A multidisciplinary team developed and implemented ICU-based mobility guidelines. Guideline implementation success was determined by comparing utilization of physical (PT) and occupational therapies (OT) and changes in functional status scale scores in preimplementation and postimplementation cohorts. The team also assessed barriers and adverse events. Results: Thirty-four patients were identified preimplementation and 55 patients postimplementation. PT/OT consultation by 72 hours occurred in 44 (81.5%) of patients postimplementation compared to 6 (17%) preimplementation (P < 0.001). Implementation did not result in more ICU-based therapy sessions or shorter time to active therapies. High deferral rates for PT/OT sessions [PT: n = 72 (46.2%) preimplementation versus 112 (39.4%) postimplementation; OT: n = 71 (46.1%) preimplementation versus 134 (41.5%) postimplementation] occurred. No difference in new morbidity between cohorts was identified. Barriers to treatment included the patient's sedation status, severity of illness, and patient availability. Conclusions: Implementation of ICU-based mobility guidelines resulted in a 4-fold increase in PT/OT consultation. They did not result in increased treatment sessions due to frequent deferrals. Future guidelines should focus on interventions to address identified barriers to treatment in a critically ill pediatric population.