Early Mobility in the ICU:The Role of the PT in Length of Stay
In the current financial climate, it is crucial for physical therapists to establish their role as cost effective members of the medical staff. A large body of research is currently exists supporting early mobility in the Intensive Care Unit (ICU) and it’s effect on reducing length of stay (LOS). Many hospitals and their staff are intimidated by the prospect of mobilization critically ill patients. Much of the trepidation comes from lack of knowledge regarding the most recent research on the positive effects of mobilization in the ICU and the improved patient outcomes.
The recent changes in health care policy are anticipated to greatly change how hospitals are reimbursed, particularly in the areas of length of stay and re-admissions. This is another realm where physical therapists can play a large role in preventing financial penalties for excessive re-admissions and longer than predicted LOS through mobilization and improving functional outcomes for patients at discharge.
With this information in mind, the goal of my project was to present an in-service to the FirstHealth Moore Regional Hospital’s acute and inpatient rehabilitation physical therapists to both educate them on the current body of evidence, learn what their current role in the ICU was, update them on the current health care policy changes, and to promote physical therapy in the role of cost effectiveness and improved functional outcomes for patients.
Literature searches for this project included the effects of early intervention PT in the ICU for various conditions including CABG surgery, acute stroke, respiratory failure, etc. and an additional search for the latest changes to health care policy and the financial impact on acute care hospitals.
The in-service I presented can be found here: Early Mobility in the ICU: The Role of the PT in Length of Stay
The feedback I received from the presentation is here: ICU Mobility Presentation Feedback
One of the exciting outcomes from the presentation was the conversation that occurred throughout and following with regards to current procedures at FirstHealth and the areas that needed change or attention. Among those were the addition of a PT specifically assigned to the ICU, the need for PT protocols for the general medical/surgical floors, and the need to understand DRG’s and PT’s portion of the payment in that equations. To wrap up the discussion and my project I chose to create an Action Plan for the establishment of a PT in the ICU and a brief summary Action Plan for the other topics discussed. Those can be found here: Action Plan for ICU PT and Summary of Additional Items Action Plan
I am pleased with the outcome of this presentation and the interest it elicited at FirstHealth. Since this will be my place of employment upon graduation I look forward to progress made towards the goals discussed.
A huge thank you to my advisor Karen McCulloch, and my committee members Heather and Donna, on the continued guidance and support throughout the development of this project.
Please feel free to leave any feedback or comments on the materials presented. I look forward to reading what you have to say!
7 Responses to “Early Mobility in the ICU: The Role of the PT in Length of Stay”
Heather
This was a great project, Kelly. I enjoyed hearing the literature supporting the need for our acute care therapists who don’t often get credit for their work. Whether you realize it or not, your presentation made our staff feel as if they were a critical part of the health care process and a key determinant in a patient’s level of success. I have found, as Karen and Donna point out, that it takes longer to affect a change within a large organization than you would originally think and that many more people want to be involved in this process than you think. I would also add that while gaining financial support from administration to hire additional therapists is one limiting factor, recruitment of such a therapist is another. You might consider adding that into the action plan as we have had many positions for acute care posted for prolonged periods without any applicants. We love our community but the draw isn’t there for everyone! Thanks for giving me the chance to be a par tof this and for helping me to learn more about our current health care environment.
Kelly
Thanks all for the comments regarding the action plan. That was my first experience creating one of those and I found it a very good system to try to implement some change. I did think the time frame may have been very optimistic, but not being familiar with the facilities workings made it hard to estimate! Look forward to seeing what comes from this. And KMac, I agree, I may have created a “job” for myself!
skauk
Hi Kelly,
Great job! All your resources were very informative and easy to read. You did a really nice job of connecting research to current and pressing issues. Thanks for this great overview of a very relevant topic.
Sarah
Karen McCulloch
Hi Kelly,
I’m glad that you were able to do this presentation and make the last part of it be an open discussion about next steps and what makes the most sense to those in attendance. Although I know soon you’ll ‘be there’ for now as a quasi-outsider, you are limited in terms of dictating what “should be done” so this was a wise and interactive way to go about it. Listen carefully to your committee person about the timelines for the action plan. I think that for those topics where others are involved – say developing a protocol for PT in ICU- if that ends up affecting nursing in terms of expectations for what they will do, then you may need a small task force that has key representatives on it to draw up that protocol (best if someone who is leadership position is able to ask for participants and include those who are good potential change agents who can help analyze how to modify practice and make it palatable to all involved). I don’t think you want a single person to devise the protocol – b/c part of that process is getting buyin from key players so that everyone is heard and compromises are made on the development end.
Once you’re talking more people, that means a longer timeline and to ensure that you have someone in a leadership role who is a good facilitiator to bring folks together who might see things differently.
I’ll be interested to see how this all plays out once you get working there – sounds like you may have a project to do whether you realized it or not 🙂
kmac
donna raye
Great job on your project Kelly! This is a very relevant topic in the current health care climate and your presentation has surely given our department a sense of empowerment. I like you action plans but the time lines may be rather optimistic. You will be an asset to the world of acute care PT.
Mary Murray
Kelly,
I love that your project led to an action plan- way to make a difference! Your action plan is very well done and complete. One suggestion I would add to the Evaluation Process would be to also track the trends in patient stay in acute care for First Health. That way a direct impact on First Health can be tracked and add some financial proof to the whole process that you put into action!
olanike
I love your topic Kelly. I enjoyed my acute care rotation at FirstHealth and understand the purpose of your capstone; I am glad you chose to explore this area. I remember as a student feeling somewhat reluctant to mobilize critically ill patient and your presentation demonstrates the benefits definitely outweigh the potential of adverse effects. I also liked that you included mobilizing patients with DVTs because this is often seen in acute care and always an area of great concern. I notice you had a section based on financial assistance for those in our profession, was this a response/solution to the staffing issue as a barrier to early mobilization in the ICU? Lastly, I love that you included outcome measures. Overall, I really liked your project, I think you did a wonderful job and I see you had some excellent feedback.
Nikki