Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Abstract

Background Mobilization of intensive care patients is a multi-professional task. Aim of this study was to explore how different professions working at Intensive Care Units (ICU) estimate the mobility capacity using the ICU Mobility Score in 10 different scenarios. Methods T en fictitious patient-scenarios and guideline-related knowledge were assessed using an online survey. Critical care team members in German-speaking countries were invited to participate. All datasets including professional data and at least one scenario were analyzed. Kruskal Wallis test was used for the individual scenarios, while a linear mixed-model was used over all responses. Results In total, 515 of 788 (65%) participants could be evaluated. Physicians (p = 0.001) and nurses (p = 0.002) selected a lower ICU Mobility Score (-0.7 95% CI -1.1 to -0.3 and -0.4 95% CI -0.7 to -0.2, respectively) than physical therapists, while other specialists did not (p = 0.81). Participants who classified themselves as experts or could define early mobilization in accordance to the “S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders” correctly selected higher mobilization levels (0.2 95% CI 0.0 to 0.4, p = 0.049 and 0.3 95% CI 0.1 to 0.5, p = 0.002, respectively). Conclusion Different professions scored the mobilization capacity of patients differently, with nurses and physicians estimating significantly lower capacity than physical therapists. The exact knowledge of guidelines and recommendations, such as the definition of early mobilization, independently lead to a higher score. Interprofessional education, interprofessional rounds and mobilization activities could further enhance knowledge and practice of mobilization in the critical care team.

Variables associated with mobility levels in critically ill patients: A cohort study

“…In another, the second barrier identified was lack of nurses. 28 According to Bakhru et al, 16 more patients per nurse implied less mobilization, but our multivariate analysis showed the opposite.…”

“…Only 12.5% of the ICUs in our study applied these protocols, 32 compared with 24 to 30% in the international study by Bakhru 16 and 45% in a study in Brazil 10 . Late mobilization could also be explained by the presence of two common barriers to EM, which are deep sedation 7,27,28 and concerns regarding haemodynamic and respiratory instability 6,12,28 …”

“…10 Late mobilization could also be explained by the presence of two common barriers to EM, which are deep sedation 7,27,28 and concerns regarding haemodynamic and respiratory instability. 6,12,28 Boehm 33 showed that as nurses' workloads increase, adherence to the ABCDEF bundle decreases substantially, and specifically, adherence to EM is affected worst, mainly because ABCDEF protocols reduce patient-days with deep sedation. 34 In Australia, 7 30% of patients were found to be too sedated for mobilization on ICU day 3, and indeed in our study, this figure was 40.8%.…”

“…Only 12.5% of the ICUs in our study applied these protocols, 32 compared with 24 to 30% in the international study by Bakhru 16 and 45% in a study in Brazil. 10 Late mobilization could also be explained by the presence of two common barriers to EM, which are deep sedation 7,27,28 and concerns regarding haemodynamic and respiratory instability. 6,12,28 Boehm 33 showed that as nurses' workloads increase, adherence to the ABCDEF bundle decreases substantially, and specifically, adherence to EM is affected worst, mainly because ABCDEF protocols reduce patient-days with deep sedation.…”

“…12,29 There is a lower presence of physiotherapists in our ICUs (5 [2][3][4][5][6][7][8][9] hours/week) compared with countries where physiotherapists are part of the ICU staff 7,10,27 and this could explain why passive mobilization is predominant. According to Garz on-Serrano, 30 McWilliams, 15 Rebel, 23 and Hermes, 28 higher levels of patient mobilization are achieved when physiotherapists lead mobilization decisions. Garz on-Serrano 30 suggests that physiotherapists, "with their specific knowledge of neurologic and musculoskeletal conditions, might be more focused on how to advance individual patients with mobilization therapy".…”