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Hill-Rom® Clinical Resource Center

Helping you implement evidence-based programs with connected technologies

Hill-Rom® Clinical Resource Center

Early Mobility

Publications

  • 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 conclude that written early mobility protocols are uncommon, infrastructure is limited, and regional differences exist.

  • Impact of Early Mobilization on Mechanical Ventilation and Cost in Neurological ICU
    Klein, K., et al. | 2015

    This secondary analysis determined the impact of an early progressive mobility protocol implemented in a 22-bed neuro ICU on hospital costs and mechanical ventilation. The original prospective pre-post study showed significant clinical outcomes, including a reduction in ICU and hospital LOS but did not evaluate cost impact.  The protocol included 4 mobility milestones, beginning in bed through ambulation. The investigators used Hill-Rom(R) TotalCare® ICU beds.  It showed a 30% reduction in overall hospital costs and a 51% reduction in ventilator days.

  • Clinical and Psychologic Effects of Early Mobilization in Patients Treated in a Neurologic ICU: A Comparative Study
    Klein K, et al. | Critical Care Medicine | 2014

    In this study in Cleveland Clinic's Neuro ICU, an early mobility program was used to mobilize 637 patients during a pre/post study. The authors found that with an early mobility program, patients had shorter ICU and hospital length of stay (LOS), were more likely to be discharged home, and had fewer complications including decreased bloodstream infections, hospital-acquired pressure ulcers, and anxiety.

  • Role of Bed Design and Head-of-Bed Articulation on Patient Migration
    Davis K, et al. | Journal of Nursing Care Quality | 2015

    Repositioning patients in bed puts both patients and caregivers at risk.  Patients experience shear and friction which are risk factors for pressure ulcers, while caregivers who are repositioning patients are at risk for lower back injuries.  This study examined the influence of hospital bed design on patient migration. In 480 trials, Bed A (Hill-Rom® Progressa® bed system) showed 85-86% (p< 0.001) less patient migration at the peak of articulation and up to 34% less torso compression compared to current alternatives.  Three in four subjects preferred the Hill-Rom® Progressa® bed system. The author concludes that optimal bed design should reduce patient migration which may lead to clinically significant reductions in health risks to patients and caregivers.

  • 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.

  • Examing the Positive Effects of Exercise in Intubated Adults in ICU: A Prospective Repeated Measures Clinical Study
    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.

  • The Effect of Increased Mobility on Morbidity in the Neurointensive Care Unit
    Titsworth WL, et al. | Journal of Neurosurgery | 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. The authors purchased additional mobility aides 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 (12.0 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 K | Critical Care Nurse | 2010

    This article reviews the risks associated with immobility (VAP, ventilation duration, pressure ulcers, reduced QOL after discharge, functional limitations), includes the definition of early mobility, and describes barriers to prioritizing positioning and mobility of patients in the ICU. The safety of mobility protocols is discussed by summarizing 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 Intensive Care: An Updated Systematic Review
    Stiller K | CHEST | 2013

    This systematic review article summarizes 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 feasible, and has human benefits that may reduce ICU and Hospital LOS.

  • Integrating a  Multidisciplinary Mobility Programme into Intensive Care Practice (IMMPTP): A Multicentre Collaborative
    Bassett RD, et al. | Intensive and Critical Care Nursing | 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 change, and education. 130 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 R, et al. | Institute for Healthcare Improvement | 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 may produce better outcomes for patients.

  • Reducing Iatrogenic Risks: ICU-acquired Delirium and Weakness--Crossing the Quality Chasm
    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, et al. | The Lancet | 2009

    This randomized trial evaluated the impact of physical and occupational therapy on functional 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, et al. | Critical Care Medicine | 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 at least one 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 | 2008

    This grand round presentation and associated article 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.

  • Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle
    Balas MC, et al. | Critical Care Medicine | 2014

    In this prospective pre/post study, the authors reviewed data on the safety and efficacy of the ABCDE bundle in seven units of a single facility. They found improvements in delirium rate and increased mobilization with no significant areas of concern regarding safety.

  • Improvements in Outcomes through a Progressive Mobility® Program in Cancer Patients
    Wright R, et al. | 2015

    In this retrospective investigation, a stepwise Progressive Mobility® Program was developed and followed in all mechanically ventilated patients admitted to a single subspecialty cancer hospital ICU. Prior studies have demonstrated improvements in LOS and ventilator days when an early mobility program was implemented, however, malignancy and short term life expectancy have been exclusions from the data. This study examines the safety and effectiveness of an early mobility program in the critically ill population of ventilated cancer patients. Patients in the intervention group showed a trend toward decreased ventilator days, as well as decreased hospital and ICU length of stay, with no difference in complications between pre and post groups related to the Progressive Mobility Protocol.

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