Adapting PICU UP! to Enhance Early Mobility in a Level IV Neonatal Intensive Care Unit: A Quality Improvement Project.

Abstract

Introduction: Patient acuity in the neonatal intensive care unit can lead to inadequate focus on developmental care. Structured approaches to promote early mobility can improve outcomes.

Methods: Our team adapted and implemented the PICU Up! program for the neonatal population and established an early mobility strategy for surgical infants born at 34 weeks' gestation or later. Our specific aim was to increase the percentage of eligible surgical patients who receive physical therapy (PT) and occupational therapy (OT) consultations from 25% and 22% to greater than 75% within 24 months. Additional measures included time to consult placement, length of stay, pressure injury rate, unplanned extubations, and fractures. The interventions tested a quality improvement framework and Plan-Do-Study-Act cycles, which included the addition of prompts on rounds, education, and documentation optimization.

Results: Control chart analysis showed that the percent of surgical admissions with PT consults increased significantly from 25% to 95% and OT consults from 22% to 95% after project initiation. Time to consultation decreased significantly from 23 to 8 days for PT and from 23 to 9 days for OT consults. There was no significant difference in length of stay, time to first extubation, number of pressure injuries, fractures, or unplanned extubations.

Conclusions: The adaptation and implementation of a standardized approach to early mobility in neonatal intensive care unit patients resulted in increased and more timely PT and OT consultations, leading to an overall improved focus on developmental care with minimal risks.