title: Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project.
abstract: OBJECTIVE
  Prolonged periods of mechanical ventilation are associated with significant physical and psychosocial adverse effects. Despite increasing evidence supporting early rehabilitation strategies, uptake and delivery of such interventions in Europe have been variable. The objective of this study was to evaluate the impact of an early and enhanced rehabilitation program for mechanically ventilated patients in a large tertiary referral, mixed-population intensive care unit (ICU).
  
  
  METHODS
  A new supportive rehabilitation team was created within the ICU in April 2012, with a focus on promoting early and enhanced rehabilitation for patients at high risk for prolonged ICU and hospital stays. Baseline data on all patients invasively ventilated for at least 5 days in the previous 12 months (n = 290) were compared with all patients ventilated for at least 5 days in the 12 months after the introduction of the rehabilitation team (n = 292). The main outcome measures were mobility level at ICU discharge (assessed via the Manchester Mobility Score), mean ICU, and post-ICU length of stay (LOS), ventilator days, and in-hospital mortality.
  
  
  RESULTS
  The introduction of the ICU rehabilitation team was associated with a significant increase in mobility at ICU discharge, and this was associated with a significant reduction in ICU LOS (16.9 vs 14.4 days, P = .007), ventilator days (11.7 vs 9.3 days, P < .05), total hospital LOS (35.3 vs 30.1 days, P < .001), and in-hospital mortality (39% vs 28%, P < .05).
  
  
  CONCLUSIONS
  A quality improvement strategy to promote early and enhanced rehabilitation within this European ICU improved levels of mobility at critical care discharge, and this was associated with reduced ICU and hospital LOS and reduced days of mechanical ventilation.
authors.affiliation: Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK. Electronic address: David.Mcwilliams@uhb.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: McWilliams
authors.affiliation: Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Weblin
authors.affiliation: Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Atkins
authors.affiliation: Critical Care, University Hospitals Birmingham NHS Foundation Trust, Queen ElizabethHospital Birmingham, Birmingham, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Bion
authors.affiliation: Critical Care, University Hospitals Birmingham NHS Foundation Trust, Queen ElizabethHospital Birmingham, Birmingham, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Williams
authors.affiliation: Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Elliott
authors.affiliation: Critical Care, University Hospitals Birmingham NHS Foundation Trust, Queen ElizabethHospital Birmingham, Birmingham, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Whitehouse
authors.affiliation: Critical Care, University Hospitals Birmingham NHS Foundation Trust, Queen ElizabethHospital Birmingham, Birmingham, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Snelson
mesh_terms: D000368:Aged; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D016730:Program Development; D058996:Quality Improvement; D012046:Rehabilitation / Q000458:organization & administration / Q000592:standards*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000523:psychology / Q000592:standards*; D013997:Time Factors
keywords: Critical Care; Exercise; ICU; Physiotherapy; Rehabilitation