Quantification of Early Physical and Occupational Therapy in a Medical ICU- An Age Friendly Health Systems Initiative

Borg, Barbara; High, Cynthia W.; Encinas, A Rodríguez; Priestley, Gail; Kuhar, Angela; Fain, Mindy J.; Bime, Christian

doi:10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a3594

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“…Secondary outcomes of interest included determining the percentage of ICU patients receiving consultation, rates of receipt of therapy, and rates of and reasons for inability to receive therapy. The preliminary results were published and presented as an abstract at prior local and international conferences 12 . Data were collected in Microsoft Excel (Microsoft Corp, Redmond, Washington).…”

Section: Methodsmentioning

confidence: 99%

Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study.

Rittel,

Borg,

Hanessian

et al. 2023

Dimens Crit Care Nurs

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Background: Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options.Objectives: Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population.Method: This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed.Results: There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, −2% to 13.5%). However, 17% of 234

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Section: Methodsmentioning

confidence: 99%