Matharsa SAA1, Jacob P1, Selvamani D1
1Heart Hospital, Hamad Medical Corporation, Cardiac Rehabilitation Department, Doha, Qatar
Background: Critical illness potentially has many consequences including profound neuromuscular weakness, psychological and cognitive disturbances that may result in long-term functional impairments. Early mobilization in the Intensive Care Unit (ICU) is used more frequently to combat disability associated with critical illness. Historically, in the Cardiothoracic Intensive Care Unit (CTICU) of Heart Hospital, the post-operative patients were on bed rest till chest tubes were removed. Furthermore, some patients were not mobilized unless the ICU physician issued an "out-of-bed mobilization" order.
In March 2015, the CTICU team implemented an early mobility program for cardiac surgery patients.
Purpose: This project aimed to investigate the feasibility of implementing an Early Mobility Protocol in CTICU for post cardiac surgery patients to increase the number of patients mobilized to more than 95%. Secondary objective was to explore the impact of the protocol on ICU length of stay.
Methods: A Multidisciplinary Mobility Task force was formulated to analyze barriers to early mobilizing of patients post-operatively. A feedback survey of CTICU staff was undertaken to identify the necessity for an Early Mobility Protocol.
A Clinical Protocol “Activities and mobilization of post cardiac surgery patients admitted in the Cardiothoracic Intensive Care Unit” was developed which got approved by “Corporate Clinical Practice Guidelines Committee” of Hamad Medical Corporation, Qatar.
All Cardiac surgery patients in CTICU were included in this project except patients receiving mechanical ventilation, patients with a neuromuscular complication, aged under 14 years, and patients with a GCS less than 13.
Evidence-based “Levels of Activity and mobilization” were developed and a mobility team was formed inclusive of CTICU Physicians, Physiotherapists and Nurses. Education and training workshops were conducted to improve staff confidence regarding early mobilization. Changes were implemented, guided by multiple Plan, Do, Study, Act cycles. Barriers to mobilization (e.g., lack of coordination) were identified and rectified.
Results: The total number of patients included from March 2015 till July 2018 was 888. This included male and female who underwent Coronary Artery Bypass Graft and Valve surgeries. 90.6% of patients progressed through the protocol. In 2015, 82.3% of patients were ambulated within 24 hours after extubation which gradually increased to 93% in 2016 and 95% in 2017, and reached 95.8% by July 2018. Staff confidence in mobilizing patients was 98.7% based on a staff feedback survey. 95.2% of patients were transferred to the ward on the first postoperative day compared to zero percentage before the program.
Conclusion(s): The results suggested that it was feasible to implement an early mobility protocol for post cardiac surgery patients in ICU. Further, an early mobility protocol enhanced ambulation of post cardiac surgery patients within 24 hours after extubation, facilitating early transfer from ICU without complication of immobility.
Implications: This early mobility protocol can be utilized to improve the standardized approach and consistency of physiotherapy care in cardiac surgery ICU; it enhances coordination and collaboration having a significant impact on confidence of the ICU multidisciplinary team; it furthermore facilitates early transfer of patients from ICU.
Keywords: Early Mobility, Cardiac Surgery, CTICU
Funding acknowledgements: This is an unfunded project
In March 2015, the CTICU team implemented an early mobility program for cardiac surgery patients.
Purpose: This project aimed to investigate the feasibility of implementing an Early Mobility Protocol in CTICU for post cardiac surgery patients to increase the number of patients mobilized to more than 95%. Secondary objective was to explore the impact of the protocol on ICU length of stay.
Methods: A Multidisciplinary Mobility Task force was formulated to analyze barriers to early mobilizing of patients post-operatively. A feedback survey of CTICU staff was undertaken to identify the necessity for an Early Mobility Protocol.
A Clinical Protocol “Activities and mobilization of post cardiac surgery patients admitted in the Cardiothoracic Intensive Care Unit” was developed which got approved by “Corporate Clinical Practice Guidelines Committee” of Hamad Medical Corporation, Qatar.
All Cardiac surgery patients in CTICU were included in this project except patients receiving mechanical ventilation, patients with a neuromuscular complication, aged under 14 years, and patients with a GCS less than 13.
Evidence-based “Levels of Activity and mobilization” were developed and a mobility team was formed inclusive of CTICU Physicians, Physiotherapists and Nurses. Education and training workshops were conducted to improve staff confidence regarding early mobilization. Changes were implemented, guided by multiple Plan, Do, Study, Act cycles. Barriers to mobilization (e.g., lack of coordination) were identified and rectified.
Results: The total number of patients included from March 2015 till July 2018 was 888. This included male and female who underwent Coronary Artery Bypass Graft and Valve surgeries. 90.6% of patients progressed through the protocol. In 2015, 82.3% of patients were ambulated within 24 hours after extubation which gradually increased to 93% in 2016 and 95% in 2017, and reached 95.8% by July 2018. Staff confidence in mobilizing patients was 98.7% based on a staff feedback survey. 95.2% of patients were transferred to the ward on the first postoperative day compared to zero percentage before the program.
Conclusion(s): The results suggested that it was feasible to implement an early mobility protocol for post cardiac surgery patients in ICU. Further, an early mobility protocol enhanced ambulation of post cardiac surgery patients within 24 hours after extubation, facilitating early transfer from ICU without complication of immobility.
Implications: This early mobility protocol can be utilized to improve the standardized approach and consistency of physiotherapy care in cardiac surgery ICU; it enhances coordination and collaboration having a significant impact on confidence of the ICU multidisciplinary team; it furthermore facilitates early transfer of patients from ICU.
Keywords: Early Mobility, Cardiac Surgery, CTICU
Funding acknowledgements: This is an unfunded project
Topic: Critical care; Cardiorespiratory
Ethics approval required: No
Institution: Hamad Medical Corporation
Ethics committee: Medical Research Center Ethical Committee
Reason not required: As this is a Quality Improvement project, it does not require ethical committee approval
All authors, affiliations and abstracts have been published as submitted.
