Original articleEarly Physical Medicine and Rehabilitation for Patients With Acute Respiratory Failure: A Quality Improvement Project
Section snippets
Overview of Project Design and Timing
This multifaceted QI project was conducted using a structured QI framework and evaluated using a before/after design. The initial phases of the QI project (ie, the “engage” and “educate” processes, as described in the Quality Improvement Process section) started in spring 2006 with increasing intensity until the 4-month “execution” phase (May to August 2007), during which early PM&R was implemented. For purposes of the before/after comparison, this execution phase is referred to as the “QI
Results
All eligible MICU patients during the pre-QI and QI periods were included in the project, representing a total of 27 and 30 patients requiring 312 and 482 MICU patient days, respectively. These patients represented approximately 10% of all MICU admissions during each of the 2 time periods. Compared with the immediately prior pre-QI period, patients in the QI period tended to be slightly older with greater comorbidities at baseline and greater severity of illness in the MICU (table 1).
Discussion
Through a structured model for QI, we learned that deep sedation was generally not necessary for patients' comfort and tolerance of mechanical ventilation. Moreover, with a change in sedation practice, ICU delirium was substantially lower and early PM&R was feasible and safe, with increased functional mobility in the MICU and substantially decreased LOS.
To our knowledge, given the relatively recent onset of interest in early PM&R in ICUs in the United States, there are no prior published QI
Conclusions
Using a structured and multifaceted QI process, we quickly and markedly reduced the use of deep sedation and increased early PM&R activities for mechanically ventilated patients. Through these activities, substantial improvements were observed in ICU delirium and patients' functional mobility, with a decrease in MICU and hospital LOS.
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Supported by the Department of Physical Medicine and Rehabilitation and the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
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