Evidence that early mobility decreases time on a ventilator, icu and hospital los. Results of a quasi-experimental study.
DiGiovine B, Bello R, Luplow K, Kenyon J, Sebastian T, Schuldt S, Bechard J, Mehboob S, Ting C, Gondolfo C, Swiderek JL, Jennings JH, and Myszenski A. Evidence that early mobility decreases time on a ventilator, icu and hospital los. Results of a quasi-experimental study. Am J Respir Crit Care Med 2018; 197.
Am J Respir Crit Care Med
A prior randomized controlled trial showed that early mobility can decrease delirium, increase vent-free days, and improve functional outcomes in ventilated patients. However, that study did not show an improvement in length of stay (LOS). Given the financial pressures in many ICUs, hospitals will be better poised to support early rehab programs if there is financial benefit as can be measured by decreased LOS. We reviewed our experience with early rehabilitation to assess impact on LOS. Methods: In July 2015, we began an early rehab program in one of our 12- bed medical ICUs at Henry Ford Hospital. We chose to compare the outcomes in this unit with a similar 12-bed medical ICU that lacked early rehab. The 2 ICUs were identical in every other way (they had the same provider staff coverage model as well as dedicated respiratory therapy, nursing, and pharmacy resources). After allowing for a run-in period, we collected data on all patients admitted to these 2 units over a 12 month period (Sept 1, 2015 - Aug 31, 2016) who were intubated upon arrival to the ICU. We collected an MPM0 on each patient at admission to control for severity of illness as well as number of demographic, clinical, and outcome measures. Continuous normally distributed outcomes are reported as mean ± SD while nonparametric outcomes are reported as median with 25th and 75th percentile and were all analyzed using nonparametric statistical tests. Results: We identified a total of 452 patients, 229 in the early rehab ICU and 223 in the control ICU. The groups were relatively well balanced with a slightly higher severity of illness in the control group. In terms of outcomes, we looked at resource use and found significantly lower length of stay, vent days, and overall costs in the patients who received early rehab. All of the crude outcomes were also reanalyzed after correcting for severity of illness and age. Outcomes remained significantly better in the early rehab group. Conclusion: The introduction of an early rehabilitation program showed significant improvements in resource allocation in a quasi-experimental design. These data can be informative for ICUs assessing the relative cost-effectiveness of an early rehab program. (Table presented)