Henderson S.B.1, Saale B.2
1University of Tennessee Medical Center, Knoxville, United States, 2University of South Alabama, Department of Physical Therapy, Mobile, United States
Background: University of Tennessee Medical Center (UTMC) implemented the ABCDE bundle in its intensive care units (ICU) in collaboration with nurses, pharmacists, respiratory therapists, physical therapists, occupational therapists, and physicians in an effort to improve patient outcomes and decrease LOS.
Purpose: The purpose of this study was to determine how incorporation of an interdisciplinary bundle focused on Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) in the ICU at UTMC affects patients' functional outcomes and length of stay (LOS).
Methods: A total of 315 subjects aged 18 years or older were evaluated by a physical therapist while in the UTMC ICU. Excluded cases include patients with terminal diagnoses; tetraplegia, paraplegia or Guillian-Barre Syndrome; non-weight bearing status of two extremities; or baseline status requiring physical assistance for gait. Using the Functional Status Score-Intensive Care Unit Tool (FSS-ICU), physical therapists or physical therapist assistants scored patients mobility on each visit. The FSS-ICU scores from the evaluation, the first visit post transfer to the floor, and the last visit prior to discharge were recorded. Data was collected for a one-month period before the ABCDE Bundle was implemented (Group A) and for a one-month period six months following implementation (Group B). Mixed-ANOVA was used to assess differences in change of FSS-ICU and LOS across time between-groups.
Results: Significant increases in FSS-ICU scores occurred for all participants, (Δ = 8.5, SD 1.1), p .001. There was not a significant interaction between Group A (Δ = 4.17, SD = 1.7) and Group B (Δ = 3.5, SD = 1.2) in change of FSS-ICU across time, p > .05. ICU and hospital LOS were not significantly different between groups, p>.05. FSS ICU scores at the first visit post transfer to floor increased more significantly in Group B than Group A for supine to sit transfer (p 0.05) and sit balance (p 0.05).
Conclusion(s): Scores on each functional element of the FSS-ICU increased significantly from initial visit to discharge for all participants. The initial total FSS-ICU score, prior to treatment, for Group B averaged 0.97 points higher than Group A which may be a result of increased focus on early mobility among other disciplines within the bundle. The scores at initial transfer to floor were significantly better for supine to sit transfers and sitting balance which may have been influenced by increased focus on early mobility in the ICU. Group B demonstrated non-significant decreases in ICU LOS of 0.59 days and hospital LOS of 0.65 days, which is clinically relevant in light of the high cost of care, especially in the ICU environment.
Implications: Prolonged immobility in an ICU can increase a patient´s functional impairment and increase the risk for additional complications. An interdisciplinary approach to initiate early mobility in the ICU may help to improve functional status and shorten LOS. Application of the ABCDE bundle promotes improved interdisciplinary communication and increased focus on early mobility. Results of this study suggest the ABCDE bundle may be an effective instrument used to improve patient outcomes and decrease ICU LOS.
Funding acknowledgements: None
Topic: Critical care
Ethics approval: Approved by the University of Tennessee Medical Center IRB in Knoxville, TN
All authors, affiliations and abstracts have been published as submitted.
