Hill-Rom® Clinical Resource Center

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Hill-Rom® Clinical Resource Center

Supporting Evidence

Early Mobility

  • Progressive Mobility in the Critically Ill
    Fitzpatrick MA, et al. | Critical Care Nurse | 2010
  • An Environmental Scan for Early Mobilization Practices in U.S. ICUs
    Bakhru RN, et al. | Critical Care Medicine | 2015

    This article discusses the findings of a survey concerning early mobilization practices and infrastructure in ICUs within the United States. The authors found that only 30% of US ICUs have a written early mobilization protocol. The authors also found that common barriers to mobilization include safety concerns, staffing levels, and competing priorities. They conclude that written early mobility protocols are uncommon, infrastructure is limited, and regional differences exist.

  • Financial Implications of a Hospital Early Mobility Program
    Bognar K, et al. | ESICM | 2015

    Significant evidence has shown that early mobility programs improve clinical outcomes for patients in critical care conditions. However, the lack of evidence associated with the financial benefit of early mobility programs has served as a barrier to program implementation. This study evaluates the financial benefits associated with the clinical outcomes of early mobility programs in the ICU environment. The study concludes that early mobility programs can generate annual savings up to $1,250,000 for a capitated delivery system, $925,000 for a Hospital, or $325,000 for a private payer.

  • The Economic Impact of Improved Clinical Outcomes with Increased Mobility in the NeuroIntensive Care Unit
    Hester JM, et al. | 2015

    Early mobility in a neurocritical ICU has shown positive clinical outcomes.  This study examines the sustainability and financial outcomes associated with an early mobility program.  The authors from UF Health-Shands Hospital, were able to maintain improvements in ICU and hospital length of stay (LOS), which yielded a 13% reduction in cost of patient care.  The authors have estimated a combined savings of $12.4 million dollars over a two year time period.  They conclude that early mobility programs are able to be implemented and sustained with positive  clinical and financial outcomes.

  • A Survey of International Practices And Infrastructure To Support Early Mobilization
    Bakhru RN, et al. | Intensive Care Medicine | 2014

    This abstract, presented at ESCIM 2014 in Barcelona, Spain summarizes the findings of an international survey concerning early mobilization practices and infrastructure. The authors found that ICU's infrequently have a written early mobilization protocol (20-30% across four researched countries). The authors also found that common barriers to mobilization include safety concerns, staffing levels and competing priorities. They conclue that written early mobility protocols are uncommon, infrastructure is limited and regional differences exist.

  • The Effect of Patient Migration in Bed on Torso Elevation
    Wiggermann N, et al. | Nursing Research | 2015

    Head of bed (HOB) elevation has been shown to reduce incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. AACN and ATS recommend HOB elevation of at least 30°. The authors of this study measured the relationship between HOB elevation and actual patient position to determine the impact of patient migration. Using motion capture methods on ten healthy participants in a lab setting, the authors were able to quantitatively determine this relationship with a linear regression. The authors conclude that patient migration results in lower HOB elevations. They further state that clinicians should consider protocols and equipment that minimize patient migration in order to help maintain guidelines recommended HOB  elevations designed to protect patients from VAP.  

  • Examining the positive effects, Winkelman, CCN, 2012
    Winkelman C, et al. | Intensive and Critical Care Nursing | 2012

    This prospective study compared clinical outcomes in ICU patients who either received standard care or an intervention comprised of 20 minutes of exercise once daily for 2-7 days. Patients in the intervention group had a significantly decreased length of stay in the ICU.

  • Safety and efficacy, Balas, CCM, poster, 2012
    Balas M | Critical Care Medicine | 2012

    This oral abstract presented at the Critical Care Congress in Jan 2013 reviews UNMC's implementation of the ABCDE bundle. It shows that is is both safe and efficacious. Through use of the ABCDE bundle, UNMC saw a reduction of 3 days per patient on a ventilator, a 9 pt reduction in cases of delirium, and an 11pt reduction in mortality.

  • The effect of increased mobility on morbidity, Titsworth, J Neurosurg, 2012
    Titsworth WL, et al. | J Neurosurg. | 2012

    This article describes a study investigating the effectiveness of increased mobility among neurointensive care unit patients. In this study, a mobility bundle toolkit was utilized, including the Progressive Upright Mobility Protocol (PUMP) algorithm, additional mobility aides were purchased, and interdisciplinary education was initiated. This resulted in increased mobility in neurointensive care unit patients by 300%, reduced LOS in the neurointensive care unit by 13%, significantly decreased hospital LOS (12 days to 8.6 days), decreased hospital-acquired infections by 60%, and significantly decreased ventilator-associated pneumonia from a rate of 2.14 per 1000 days to 0. Increased mobility did not lead to increases in adverse events.

  • Introduction to progressive mobility, Vollman, CCN, 2010
    Vollman K | Crit Care Nurse | 2010

    This article reviews the risks associated with immobility (VAP, vent stay, pressure ulcers, reduced QOL after discharge, functional limitations), defines the process of early mobility, and describes barriers to prioritizing positioning and mobility of patients in the ICU. The safety of mobility protocols is reviewed by discussing a study of 103 ICU patients undergoing mobilization, in which <1% experienced an AE due to early mobilization and 69% could ambulate >100 ft. at ICU discharge.

  • Physiotherapy in ICU, Stiller, A Syst Review, 2013
    Stiller K | CHEST | 2013

    This systematic review articles summarize all papers published from 1999 through 2013 on the topic of physiotherapy in the ICU. It found 85 new articles on the subject, with 26 specifically on the use of early mobility. The findings are clear that early mobility is safe and efficacous, and has human benefits that can reduce ICU and Hospital LOS.

  • Integrating a multi mobility program, Bassett, CCN, 2012
    Bassett RD, et al. | Intensive Crit Care Nurse | 2012

    This article describes an initiative to implement an evidence-based early mobility continuum into current ICU culture in 8 hospitals in the United States. This multicenter initiative included process design, culture work, and education. One hundred thirty patients were evaluated, and the results showed substantial utilization of physical therapy within 24 hours of admission and a reduction in ventilator days (3.0 days pre vs. 2.1 days post; p=0.06).

  • Using care bundles to improve health care quality, Resar, IHI, 2012
    Resar R, et al. | 2012

    This Institute for Healthcare Improvement white paper provides a great overview of what a healthcare bundle is and the historic context for why they were developed. It then discusses why bundles produce better outcomes for patients.

  • Reducing iatrogenic risks: ICU-acquired delirium and weakness crossing the quality chasm, Vasilevskis EE, Chest, Nov 2010
    Vasilevskis EE, et al. | CHEST | 2010

    This article describes strategies for the implementation of a bundle of evidence-based strategies for reducing mortality due to ICU-acquired delirium and weakness: awakening and breathing coordination, delirium monitoring, and exercise/early mobility. Inadequate technology is cited as a barrier to implementation of early mobility therapy.

  • Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial, Schweickert, Lancet, May 2009
    Schweickert, et al. | The Lancet | 2009

    This randomized trial evaluated the impact of physical and occupational therapy on function outcomes in mechanically vented patients in the ICU. Of 104 patients, 59% returned to independent functional status at discharge in the intervention arm compared with 35% in the control arm. Patients in the intervention arm also had shorter duration of delirium (P=0.02) and more ventilator-free days (P=0.05) compared to the control arm. Discontinuation due to patient instability occurred in 4% of all therapy sessions.

  • Early intensive care unit mobility therapy in the treatment of acute respiratory failure, Morris PE, Crit Care Med, Aug 2008
    Morris PE, et al. | Crit Care Med. | 2009

    This prospective cohort study evaluated the impact of implementing a mobility protocol on the proportion of ICU patients receiving physical therapy vs. usual care. Eighty percent of protocol patients received greater than 1 physical therapy session compared to usual care (47%). Protocol patients were out of bed 6 days earlier than SICU patients. ICU stay was improved by 1.4 days (P=0.025), and hospital length of stay was improved by 3.3 days (P=0.006) in protocol patients.

  • Mobilizing patients in the intensive care unit improving neuromuscular weakness and physical function, Needham D, JAMA, Oct 2008
    Needham, D | JAMA | 2008

    This grand rounds presentation and assocaited articles summarizes the challenges patients and hospitals face with immobility, provides the historical background on the matter, and reviews the evidence supporting an early mobility protocol. It then discusses Johns Hopkins experience implementing such a protocol.

  • Safe Patient Handling and Mobility: Interprofessional National Standards, Matz, ANA, 2013
    Matz MW, et al. | Amer Nur Assn. | 2013

    This interprofessional national standard from the American Nurses Association reviews the need for safe patient handling and mobility for healthcare reciepients and care providers in terms of safety for all involved. It proposes eight standards that are relevant to those involved regardless of the care setting.

  • Delirium assessment, Bell, AACN, 2011
    2011

    This practice alert make recommendations on delirium assessment and management. These recommendations include assessing all ICU patients for delirium using validated tools and implementing strategies to decrease delirium risk fators including early exercise.

  • Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit, Barr J, Crit Care Med, Jan 2013
    2013

    These practice guidelines make recommendations on the management of pain, agitation, and delirium in adult patients in the ICU. The article discusses the association of delirium with increased mortality in adult ICU patients, prolonged ICU and hospital LOS, and the development of post-ICU cognitive impairment. Recommendations include performing early mobilization of adult ICU patients whenever feasible to reduce the incidence and duration of delirium

  • Safe Patient Handling and Mobility: Interprofessional National Standards, Matz, ANA, 2013
    2013

    This interprofessional national standard from the American Nurses Association reviews the need for safe patient handling and mobility for healthcare reciepients and care providers in terms of safety for all involved. It proposes eight standards that are relevant to those involved regardless of the care setting

  • ICU Early physical rehab, Lord, CCM, 2013
    2013

    This articles provides a framework for financial justification of implementing an early mobility protocol in ICU's. It uses previously published cost data with measured reductions in ICU and Hospital Length of Stay to provide the financial justification. John's Hopkins saw a net cost savings of $817,836 from their investment in an early mobility protocol and technology

  • Progressive Mobility Program
    2013

    The evidence is in, and early mobility can help you improve your patients health as well as your hospitals bottom line. Learn how our expert clinicians can help you get your patients moving today

  • Early Mobilization: Update and Physician Perspective (Video)
    Schweickert W | 2014

    In this 30min video, Dr. William Schweickert of University of Pennsylvania, details the importance of early mobility in critically ill patients and how to bridge the implementation gap.  He also summarizes findings from his recent work on the recent publication: A Survey Of International Practices And Infrastructure To Support Early Mobilization which showed that <30% of global ICU’s have a written early mobility protocol and known barriers can be overcome.  He concludes with a proposed framework for early mobilization and practical advice to get started.

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