Hester Jeannette M, Guin Peggy R, Danek Gale D, Thomas Jaime R, Titsworth William L, Reed Richard K, Vasilopoulos Terrie, Fahy Brenda G
1Department of Nursing and Patient Services, UF Health Shands Hospital, Gainesville, FL. 2Department of Neurosurgery, University of Florida, Gainesville, FL. 3Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL. 4Department of Anesthesiology and Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL.
Crit Care Med. 2017 Jun;45(6):1037-1044. doi: 10.1097/CCM.0000000000002305.
To investigate a progressive mobility program in a neurocritical care population with the hypothesis that the benefits and outcomes of the program (e.g., decreased length of stay) would have a significant positive economic impact.
Retrospective analysis of economic and clinical outcome data before, immediately following, and 2 years after implementation of the Progressive Upright Mobility Protocol Plus program (UF Health Shands Hospital, Gainesville, FL) involving a series of planned movements in a sequential manner with an additional six levels of rehabilitation in the neuro-ICU at UF Health Shands Hospital.
Thirty-bed neuro-ICU in an academic medical center.
Adult neurologic and neurosurgical patients: 1,118 patients in the pre period, 731 patients in the post period, and 796 patients in the sustained period.
Implementation of Progressive Upright Mobility Protocol Plus.
ICU length of stay decreased from 6.5 to 5.8 days in the immediate post period and 5.9 days in the sustained period (F(2,2641) = 3.1; p = 0.045). Hospital length of stay was reduced from 11.3 ± 14.1 days to 8.6 ± 8.8 post days and 8.8 ± 9.3 days sustained (F(2,2641) = 13.0; p < 0.001). The impact of the study intervention on ICU length of stay (p = 0.031) and hospital length of stay (p < 0.001) remained after adjustment for age, sex, diagnoses, sedation, and ventilation. Hospital-acquired infections were reduced by 50%. Average total cost per patient after adjusting for inflation was significantly reduced by 16% (post period) and 11% (sustained period) when compared with preintervention (F(2,2641) = 3.1; p = 0.045). Overall, these differences translated to an approximately $12.0 million reduction in direct costs from February 2011 through the end of 2013.
An ongoing progressive mobility program in the neurocritical care population has clinical and financial benefits associated with its implementation and should be considered.
在神经重症监护人群中研究一项渐进性活动计划，假设该计划的益处和结果（如缩短住院时间）将产生显著的积极经济影响。
对实施渐进式直立活动方案升级版（UF Health Shands医院，佛罗里达州盖恩斯维尔）之前、实施后即刻以及实施后2年的经济和临床结果数据进行回顾性分析，该方案在UF Health Shands医院神经重症监护病房以一系列有序的方式进行计划活动，并增加六个康复级别。
一所学术医疗中心的拥有30张床位的神经重症监护病房。
成年神经科和神经外科患者：前期1118例，后期731例，持续期796例。
实施渐进式直立活动方案升级版。
实施后即刻重症监护病房住院时间从6.5天降至5.8天，持续期降至5.9天（F(2,2641)=3.1；p = 0.045）。住院时间从11.3±14.1天降至实施后8.6±8.8天和持续期8.8±9.3天（F(2,2641)=13.0；p<0.001）。在对年龄、性别、诊断、镇静和通气进行调整后，研究干预对重症监护病房住院时间（p = 0.031）和住院时间（p<0.001）的影响依然存在。医院获得性感染减少了50%。与干预前相比，调整通货膨胀因素后每位患者的平均总成本在后期显著降低了16%，在持续期降低了11%（F(2,2641)=3.1；p = 0.045）。总体而言，这些差异使得2011年2月至2013年底的直接成本减少了约1200万美元。
在神经重症监护人群中持续开展的渐进性活动计划在实施过程中具有临床和经济效益，应予以考虑。
