Dimpi A Patel, Shannon M Stillwell, Sara E Booth, Meredith A Schofield, Anna E Silverstein, Alyse M Reichheld, Roberto J Gonzalez, Brian J McDonnell, Susy L Carnevale, Jacqueline L Joy, Adrienne Cronin, Ashley L O'Donoghue, James R Devanney, Ryan M Gould, Elaine M Klatt, Stephanie Li, Margaret M Hayes, Jennifer P Stevens, David M Furfaro
{"title":"多学科方法在学术医疗中心早期活动。","authors":"Dimpi A Patel, Shannon M Stillwell, Sara E Booth, Meredith A Schofield, Anna E Silverstein, Alyse M Reichheld, Roberto J Gonzalez, Brian J McDonnell, Susy L Carnevale, Jacqueline L Joy, Adrienne Cronin, Ashley L O'Donoghue, James R Devanney, Ryan M Gould, Elaine M Klatt, Stephanie Li, Margaret M Hayes, Jennifer P Stevens, David M Furfaro","doi":"10.1097/CCM.0000000000006890","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>ICU-acquired weakness affects 50% of critically ill patients. Early mobility programs have been shown to improve functional status at hospital discharge, shorten duration of mechanical ventilation, prevent delirium, and reduce length of stay. Despite these benefits, early mobility is one of the most difficult parts of the ABCDEF bundle to incorporate into practice. This project sought to use a multidisciplinary intervention to improve mobility in the ICU.</p><p><strong>Design: </strong>Randomized, pragmatic design quality improvement study.</p><p><strong>Setting: </strong>Two ICUs at a large academic medical center between July 2023 and February 2024.</p><p><strong>Patients: </strong>Five hundred seventy-four ICU patients with 271 in the intervention ICU and 276 in the control ICU.</p><p><strong>Interventions: </strong>A multidisciplinary quality improvement initiative focused on increasing education, raising awareness, and addressing barriers.</p><p><strong>Measurements and main results: </strong>Our primary outcome was achievement of an intensity-specific mobility goal with nursing staff on a patient-day level. A difference-in-differences model was used to evaluate the association between the mobility intervention and mobility goal achievement. The percentage of daily mobility goals met increased from 48.6% pre-intervention to 65.4% post-intervention in the intervention ICU (p < 0.001). There was no significant difference in daily mobility goal adherence between the intervention and control ICU pre-intervention, but post-intervention, the intervention ICUs adherence was significantly higher (65.4% vs. 43.0%; p < 0.001). After controlling for demographic, clinical, and ICU characteristics, the intervention ICU was 1.96 times more likely to reach the daily mobility goal on a patient-day level (p = 0.017). There was no significant change in ICU length of stay, inpatient length of stay, discharge to home, or in-hospital mortality between patients treated in the intervention vs. control ICU.</p><p><strong>Conclusions: </strong>A multidisciplinary quality improvement initiative can improve adherence to daily mobility goals.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Multidisciplinary Approach to Early Mobility at an Academic Medical Center.\",\"authors\":\"Dimpi A Patel, Shannon M Stillwell, Sara E Booth, Meredith A Schofield, Anna E Silverstein, Alyse M Reichheld, Roberto J Gonzalez, Brian J McDonnell, Susy L Carnevale, Jacqueline L Joy, Adrienne Cronin, Ashley L O'Donoghue, James R Devanney, Ryan M Gould, Elaine M Klatt, Stephanie Li, Margaret M Hayes, Jennifer P Stevens, David M Furfaro\",\"doi\":\"10.1097/CCM.0000000000006890\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>ICU-acquired weakness affects 50% of critically ill patients. Early mobility programs have been shown to improve functional status at hospital discharge, shorten duration of mechanical ventilation, prevent delirium, and reduce length of stay. Despite these benefits, early mobility is one of the most difficult parts of the ABCDEF bundle to incorporate into practice. This project sought to use a multidisciplinary intervention to improve mobility in the ICU.</p><p><strong>Design: </strong>Randomized, pragmatic design quality improvement study.</p><p><strong>Setting: </strong>Two ICUs at a large academic medical center between July 2023 and February 2024.</p><p><strong>Patients: </strong>Five hundred seventy-four ICU patients with 271 in the intervention ICU and 276 in the control ICU.</p><p><strong>Interventions: </strong>A multidisciplinary quality improvement initiative focused on increasing education, raising awareness, and addressing barriers.</p><p><strong>Measurements and main results: </strong>Our primary outcome was achievement of an intensity-specific mobility goal with nursing staff on a patient-day level. A difference-in-differences model was used to evaluate the association between the mobility intervention and mobility goal achievement. The percentage of daily mobility goals met increased from 48.6% pre-intervention to 65.4% post-intervention in the intervention ICU (p < 0.001). There was no significant difference in daily mobility goal adherence between the intervention and control ICU pre-intervention, but post-intervention, the intervention ICUs adherence was significantly higher (65.4% vs. 43.0%; p < 0.001). After controlling for demographic, clinical, and ICU characteristics, the intervention ICU was 1.96 times more likely to reach the daily mobility goal on a patient-day level (p = 0.017). 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引用次数: 0
摘要
目的：重症监护病房获得性虚弱影响50%的危重患者。早期活动计划已被证明可以改善出院时的功能状态，缩短机械通气时间，防止谵妄，缩短住院时间。尽管有这些好处，但早期的移动性是ABCDEF包中最难融入实践的部分之一。本项目试图采用多学科干预来改善ICU患者的活动能力。设计：随机、实用的设计质量改进研究。场景：2023年7月至2024年2月期间，在一个大型学术医疗中心的两个icu。患者：574例ICU患者，干预ICU 271例，对照组276例。干预措施：多学科质量改进计划，侧重于增加教育、提高认识和解决障碍。测量和主要结果：我们的主要结果是护理人员在患者日水平上实现了特定强度的流动性目标。采用差异中的差异模型评估移动性干预与移动性目标实现之间的关系。干预ICU患者每日活动目标达到率从干预前的48.6%上升至干预后的65.4% （p < 0.001）。干预前与对照ICU患者每日活动能力目标依从性差异无统计学意义，但干预后干预ICU患者每日活动能力目标依从性显著高于对照组（65.4% vs. 43.0%, p < 0.001）。在控制了人口统计学、临床和ICU特征后，干预ICU在患者日水平上达到日常活动目标的可能性高出1.96倍（p = 0.017）。在干预组与对照组ICU治疗的患者在ICU的住院时间、住院时间、出院或住院死亡率方面没有显著变化。结论：多学科质量改进计划可以提高对日常活动目标的依从性。
Multidisciplinary Approach to Early Mobility at an Academic Medical Center.
Objectives: ICU-acquired weakness affects 50% of critically ill patients. Early mobility programs have been shown to improve functional status at hospital discharge, shorten duration of mechanical ventilation, prevent delirium, and reduce length of stay. Despite these benefits, early mobility is one of the most difficult parts of the ABCDEF bundle to incorporate into practice. This project sought to use a multidisciplinary intervention to improve mobility in the ICU.
Setting: Two ICUs at a large academic medical center between July 2023 and February 2024.
Patients: Five hundred seventy-four ICU patients with 271 in the intervention ICU and 276 in the control ICU.
Interventions: A multidisciplinary quality improvement initiative focused on increasing education, raising awareness, and addressing barriers.
Measurements and main results: Our primary outcome was achievement of an intensity-specific mobility goal with nursing staff on a patient-day level. A difference-in-differences model was used to evaluate the association between the mobility intervention and mobility goal achievement. The percentage of daily mobility goals met increased from 48.6% pre-intervention to 65.4% post-intervention in the intervention ICU (p < 0.001). There was no significant difference in daily mobility goal adherence between the intervention and control ICU pre-intervention, but post-intervention, the intervention ICUs adherence was significantly higher (65.4% vs. 43.0%; p < 0.001). After controlling for demographic, clinical, and ICU characteristics, the intervention ICU was 1.96 times more likely to reach the daily mobility goal on a patient-day level (p = 0.017). There was no significant change in ICU length of stay, inpatient length of stay, discharge to home, or in-hospital mortality between patients treated in the intervention vs. control ICU.
Conclusions: A multidisciplinary quality improvement initiative can improve adherence to daily mobility goals.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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