Domann Jenna E, Davies Lindsay E, Zivick Elizabeth E, Johnson Laken, Keller Everette P, Walz Alice A
From the Department of Physical & Occupational TherapyMUSC Children's Health, Charleston, S.C.
Division of Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, S.C.
Pediatr Qual Saf. 2025 Jan 7;10(1):e783. doi: 10.1097/pq9.0000000000000783. eCollection 2025 Jan-Feb.
Mobilization protocols are safe and feasible for critically ill pediatric patients in the intensive care unit (ICU), but barriers exist to sustainability. This study described a focused early mobility protocol, sustained over 5 years, which is on time for therapy consults and patient mobilization at a single institution.
A formal ICU mobility protocol was implemented as part of a unit-wide ICU liberation bundle. As part of the ongoing program assessment, over a specific 3-month timeframe annually from 2017 to 2023, the number of physical and occupational therapy (PT/OT) consults, mobilization rate, and time to PT/OT consult were analyzed. In addition, in 2023, we assessed specific barriers to early PT/OT consultation.
Annually, for each study timeframe, there was a sustained decrease in time to therapy consult from a mean of 3.8 days for PT and 7 days for OT in 2017 to 1.9 and 1.6 days, respectively, in 2023. Similarly, the mobilization rate increased from 20.3 sessions per 100 patient days in 2017 to 48.2 in 2023. There was a trend toward missed or delayed therapy consults at times of higher ICU census. No adverse events were associated with mobilization.
An ICU early mobility protocol leads to a sustained decrease in the time to therapy consultation, an increase in the number of therapy consults, and an increase in the mobilization rate. Future interventions should focus on mitigating barriers to timely consultation, specifically at times of higher ICU census.
对于重症监护病房（ICU）中的危重症儿科患者，动员方案是安全可行的，但在可持续性方面存在障碍。本研究描述了一项在单一机构实施的、持续5年的重点早期活动方案，该方案在治疗咨询和患者活动方面均按时进行。
作为全科室ICU解放综合措施的一部分，实施了一项正式的ICU活动方案。作为正在进行的项目评估的一部分，在2017年至2023年每年特定的3个月时间范围内，分析物理治疗和职业治疗（PT/OT）咨询的次数、活动率以及PT/OT咨询的时间。此外，在2023年，我们评估了早期PT/OT咨询的具体障碍。
在每个研究时间段内，每年治疗咨询时间持续减少，从2017年PT的平均3.8天和OT的平均7天分别降至2023年的1.9天和1.6天。同样，活动率从2017年每100患者日20.3次增加到2023年的48.2次。在ICU查房人数较多时，存在错过或延迟治疗咨询的趋势。没有不良事件与活动相关。
ICU早期活动方案导致治疗咨询时间持续减少、治疗咨询次数增加以及活动率提高。未来的干预措施应侧重于减轻及时咨询的障碍，特别是在ICU查房人数较多时。
