A Quality Improvement Initiative to Optimize Early Mobilization in Acute Intracerebral Hemorrhage: A Pre-Post Intervention Study.

Abstract

BackgroundPrimary intracerebral hemorrhage (ICH) carries high mortality and disability risks. Although early mobilization is beneficial, concerns about physiological instability often delay mobilization.ObjectiveTo evaluate whether a structured early mobilization protocol improves functional mobility and reduces adverse events in critically ill ICH patients.MethodThis retrospective pre-post study included 192 patients with ICH (ICH score 0-4) admitted to a dedicated stroke center. In the pre-implementation phase in 2022, patients received standard care. In the post-implementation phase in 2023, a standardized mobility protocol, incorporating time-based stratification, neurological thresholds, and safety criteria to guide activity progression, was introduced. Primary outcomes included the Modified ICU Mobility Scale (MIMS) score at intensive care unit (ICU) discharge and the occurrence of adverse events.ResultsThe post-implementation group (99 patients) showed higher MIMS scores at ICU discharge, with a greater proportion achieving out-of-bed sitting during their ICU stay compared to the pre-implementation group (93 patients). Non-serious adverse events in the former decreased significantly; ICU and hospital lengths of stay were shorter but not statistically significant.ConclusionThe structured pathway enabled safer, earlier mobilization and improved ICU functional outcomes. While mobility benefits were observed, caution is warranted in interpreting non-significant trends in length of stay.