Progressive Mobility Among Critically Ill and Critically Injured Patients: An Examination of Clinical Outcomes Prior to the Implementation of Standardized Guidelines

Objectives:

1. Identify patterns of mobilization among critically ill and critically injured patients.
2. Identify if patient demographic variables and mobility are associated with specific quality metrics.

Statement of the Problem

Immobility associated pressure ulcers, VAP, DVT and neuromuscular deconditioning have historically been viewed as anticipated risks among critical care and critically injured patient populations.^1,2 In fact, alarming critical care pressure ulcer prevalence rates of 26-82%^3-5, VAP rates of 17-67%^6,7, PE rates of 24%⁸ and DVT rates of 33%⁹ have been reported. Increased mortality, morbidity, LOS, prolonged functional disability, and associated costs of these hospital acquired conditions (HAC) raise serious concerns regarding current care practices, especially in view of the CMS HAC No-Pay Ruling.¹⁰

Methodology:

This study consisted of retrospective review of 700 medical records and corresponding APACHE III data  prior to implementation of mobility guidelines . Data was collected utilizing a pilot tested tool. The tool was developed based: on a systematic review of critical care and trauma literature, a review by the study site’s Mobility Team and trauma surgeons from three Level I Trauma Centers, ensuring content and construct validity. Formal training was provided to data abstractors. Outcomes measured in the aggregate and strata included: LOS, disposition, DVT, PE, ventilator days, falls, pressure ulcers, nutrition initiation, use of physical restraints, and time to mobilization.

Sampling

Adult  ICU admissions in 2007 were stratified by APACHE III coding and randomized. Subjects included were: at least age 18 and had ICU stays of at least 48 hours. Those excluded were: under age 18, on planned withdrawal of life support or cardiothoracic surgery patients.

Data Analysis:

Descriptive and correlational statistical analyses will be performed. Results will be expressed as percentages for categorical variables and means or medians for continuous variables. Univariate analyses such as chi-squared test, t-test and ANOVA will be used.