Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative

Ames, Stefanie; Alessi, Lauren; Chrisman, Maddie; Stanger, Meg; Corboy, Devin; Sinha, Amit; Fink, Ericka L.

doi:10.1097/pq9.0000000000000414

Cited by 5 publications

(11 citation statements)

References 31 publications

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“…There were six unique study designs applied to QI publications, of which 34 studies (49%) 28,32-34,36,37,39,41,42,45-48,50-53,55,58,59,67,68,70,72,74,77,95-102 used a pre-post design. The second most commonly used design was an adaptive-iterative design ( n = 17, 24%) 29,30,35,38,54,56,57,61,63-66,73,75,78,80,93 in which studies reported using multiple cycles of improvement that were informed and adapted based on initial successes or failures.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 70 total included studies in this review, 18 (26%) 28,37,39,40,43-45,48,52,60,68,70,73,74,77,79,96,102 were approved by local ethics boards, 19 (27%) 32-34,36,41,46,47,49,50,53,55,56,58,63,64,67,81,97,100 sought approval but were considered exempt, 15 (21%) 19,35,38,42,57,59,61,62,65,71,72,75,78,80,93 reported that seeking approval was not necessary at their institution based on the type of project proposed and current regulations, and 18 (26%) 27,29-31,51,54,66,69,76,88,89,95,98,99,101,103-105 made no mention of ethics oversight.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two studies (31%) 27,28,33,[39][40][41]59,62,66,68,71,72,74,78,[95][96][97][98][100][101][102][103] were conducted in an adult intensive care unit (ICU), whereas six others (8.5%) 34,42,45,46,55,77 involved pediatric ICU practice. The second most common service level involved QI efforts in orthopedics (n 5 11, 15.7%).…”

Section: Service Levelmentioning

confidence: 99%

“…Fifty-three studies (76%) reported some form of descriptive statistics, whereas 40 (57%) studies 19,28,[32][33][34][35]37,[39][40][41][43][44][45][46][47][48]50,52,56,59,62,[66][67][68]70,72,74,75,[77][78][79][80][81]89,[95][96][97][100][101][102] reported some type of inferential statistics. Qualitative analysis was used alone in one study (1.8%), 71 but was combined with additional analytic techniques in seven other studies (10%).…”

Section: Analytical Plan Reportedmentioning

confidence: 99%

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The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

Crick¹,

Rethorn²,

Beauregard³

et al. 2023

J Healthc Qual

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Introduction: Quality improvement (QI) is a useful methodology for improving healthcare, often through iterative changes. There is no prior review on the application of QI in physical therapy (PT). Purpose and Relevance: To characterize and evaluate the quality of the QI literature in PT. Methods: We searched four electronic databases from inception through September 1, 2022. Included publications focused on QI and included the practice of PT. Quality was assessed using the 16-point QI Minimum Quality Criteria Set (QI-MQCS) appraisal tool. Results: Seventy studies were included in the review, 60 of which were published since 2014 with most (n = 47) from the United States. Acute care (n = 41) was the most prevalent practice setting. Twenty-two studies (31%) did not use QI models or approaches and only nine studies referenced Revised Standards for QI Reporting Excellence guidelines. The median QI-MQCS score was 12 (range 7–15). Conclusions/Implications: Quality improvement publications in the PT literature are increasing, yet there is a paucity of QI studies pertaining to most practice settings and a lack of rigor in project design and reporting. Many studies were of low-to-moderate quality and did not meet minimum reporting standards. We recommend use of models, frameworks, and reporting guidelines to improve methodologic rigor and reporting.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Service Levelmentioning

confidence: 99%

Section: Analytical Plan Reportedmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

Crick¹,

Rethorn²,

Beauregard³

et al. 2023

J Healthc Qual

View full text Add to dashboard Cite

show abstract

“…In children, sedation is an obstacle to early mobilization. Sedation in children differs from sedation in adults because of safety issues and evaluation of pain and anxiety in small children [67]. The level of evidence of the signs specified in the Comments.…”

Section: Comments Stop-signs Include Signs That Show the Maximal Rate...mentioning

confidence: 99%

Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists

Белкин

Belkin

et al. 2022

Annals of Critical Care

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Выписываясь из отделения анестезиологии, реанимации и интенсивной терапии, более 50 % пациентов испытывают патологические симптомы, не имеющие отношения к первичному неотложному состоянию, но снижающие качество жизни и требующие реабилитации. Совокупность таких симптомокомплексов называется «синдром последствий интенсивной терапии» (ПИТC). ПИТС включает: комплекс инфекционно-трофических, вегетативно-метаболических (хронизирующийся болевой синдром, нарушение циркадных ритмов, гравитационного градиента, нейромышечных (полимионейропатия критических состояний, респираторная нейропатия, дисфагия бездействия), эмоционально-когнитивных осложнений (депрессия, делирий, снижение памяти и пр.). Патофизиологической основой ПИТС является феномен «наученного неиспользования» (learned non-use), состояние искусственного ограничения двигательной и когнитивной активности пациента в результате применения анальгоседации, постельного режима и иммобилизации. Клиническая картина ПИТС определяется выраженностью отдельных его компонентов, детализируемых с применением пакета клиниметрических шкал. На основе результатов динамического тестирования рассчитывается индекс тяжести ПИТС. Сумма баллов в диапазоне от 0 до 10 отражает как факт наличия ПИТС, так и степень тяжести и потенциал реабилитационных мероприятий. Для профилактики ПИТС Союзом реабилитологов России совместно с Федерацией анестезиологов и реаниматологов России разработан реабилитационный комплекс РеабИТ. В англоязычной литературе такой комплекс называется “Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility” (ABCDEF bundle). РеабИТ — комплекс технологически лечебно-диагностических модулей «позиционирование и мобилизация», «профилактика дисфагии и нутритивного дефицита», «профилактика эмоционально-когнитивных нарушений и делирия», «профилактика утраты навыков самообслуживания». В соответствии с федеральным Порядком организации реабилитационной помощи для реализации РеабИТ предусмотрена организация отделения ранней реабилитации. Основу отделения составляет мультидисциплинарная реабилитационная команда, в которую входит врач по медицинской реабилитации, не менее 2 специалистов по физической реабилитации, специалист по эргореабилитации, медицинский психолог/врач-психотерапевт, медицинский логопед, медицинская сестра по медицинской реабилитации. Деятельность отделения ранней реабилитации оценивается на основании критериев качества и достижении основной цели РеабИТ — сохранение преморбидного статуса социализированности пациента. Пациенты с развившимся ПИТС маршрутизируются на этапы реабилитационного лечения с использованием шкалы реабилитационной маршрутизации на основе телемедицинских технологий.

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Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study

et al. 2023

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Background: Falls in and following hospitalization are common and problematic. Little is understood about the factors that impede or promote effective implementation of fall prevention practices. Purpose and Relevance: Physical therapists are commonly consulted for acute care patients at risk for falling. The purpose of this study is to understand therapist perceptions of their effectiveness in fall prevention and to explore the impact of contextual factors on practice patterns to prevent falls surrounding hospitalization. Methods: Survey questions were tailored to the constructs of hospital culture, structural characteristics, networks and communications, and implementation climate, in addition to inquiries regarding practice patterns and attitudes/beliefs. Results: Overall, 179 surveys were analyzed. Most therapists (n 5 135, 75.4%) affirmed their hospital prioritizes best practices for fall prevention, although fewer agreed that therapists other than themselves provide optimal fall prevention intervention (n 5 105, 58.7%). Less practice experience was associated with greater odds of affirming that contextual factors influence fall prevention practice (odds ratio 3.90, p , .001). Respondents who agreed that their hospital system prioritizes best practices for fall prevention had 14 times the odds of believing that their system prioritizes making improvements (p 5 .002). Conclusions/Implications: As experience influences fall prevention practice, quality assurance and improvement initiatives should be used to ensure minimum specifications of practice.

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Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative

Abstract: Supplemental Digital Content is available in the text.

Cited by 5 publications

References 31 publications

The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

The Use of Quality Improvement in the Physical Therapy Literature: A Scoping Review

Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists

Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study

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