Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers

Abstract

IntroductionMobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses.MethodsThe objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first. Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU.ResultsTen tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery (43.3 %), whereas the Scottish cohort had none. Therefore, comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay (p < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard ratio 1.83, 95 % confidence interval 1.38–2.42). However, the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort (41.1 % vs 16.3 %, p < 0.001). Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability and the presence of an endotracheal tube were also frequently reported barriers.ConclusionsThis is the first study to benchmark baseline practise of early mobilisation internationally, and it demonstrates variation in early mobilisation practises between Australia and Scotland.

Quality improvement: The delivery of true early mobilisation in an intensive care unit

“…Few centres achieve Hodgson's definition of early mobilisation within 2-5 days10 16 27. Our QI project has enabled patients to mobilise out of bed within the first five days of their intensive care stay and to be discharged earlier from the ICU.…”

Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units

“…Prospectively defined and empirically evaluated barriers, as previously defined, were found in 17 studies (9,11,(13)(14)(15)(16)19,(23)(24)(25)(27)(28)(29)34,35,41,50), perceived barriers in 19 studies (12,(20)(21)(22)26,(31)(32)(33)(36)(37)(38)(39)(43)(44)(45)(46)(47)(48)(49) and a mix of both in 4 studies (10,30,40,42) (Table E1). Only 1 study used a validated instrument for the assessment of barriers (37), while other studies identified barriers using a variety of techniques, including interdisciplinary meetings (10,12,21,30,42) and interviews or custom-made surveys with clinicians…”

“…Interprofessional meetings † *; PT screening of ICU patients † * 32,41,42,46 Hemodynamic instability, arrhythmias Stepwise approach † ‡ *; protocols † ‡ *; safety criteria † ‡ *; avoid mobilization until 2 hours after increase in vasopressor dose † *, valid assessment † ‡ * 9,10,19,23,24,26,31,44,46,48,50 Respiratory instability/distress, ventilator asynchrony…”

What's in this Issue

“…Indeed, the data segments presented in this study highlight the value of qualitative oriented research in eliciting clinicians' difficulties in everyday clinical practice, even when using diagnostic instruments deemed as valid and reliable through quantitative studies. They also suggest that such instruments need to be regularly revisited, especially in view of the trend towards less sedation and earlier mobilization in ICUs in various countries (Harrold et al, 2015;Leong et al, 2017). Nydahl et al (2018) also recruited a combination of nurses and doctors (n = 559) through snowball sampling in a study about delirium, but in their case sought to investigate delirium management practices in critical care units in German-speaking countries in Europe.…”