title: Implementing and sustaining an early rehabilitation program in a medical intensive care unit: A qualitative analysis.
abstract: OBJECTIVE
  Early rehabilitation programs in a medical intensive care unit can improve patient outcomes, but clinicians face barriers in implementing and sustaining such programs. We sought to describe a multidisciplinary team perspective regarding how to implement and sustain a successful early rehabilitation program.
  
  
  METHODS
  Semistructured interviews were conducted with 20 staff and faculty who were involved in the early rehabilitation program at the Johns Hopkins Hospital Medical Intensive Care Unit. Transcripts were evaluated using the Consolidated Framework of Implementation Research Theory.
  
  
  RESULTS
  Four major constructs emerged as important, as follows: (1) necessary components, (2) implementation strategies, (3) perceived barriers, and (4) positive outcomes. All participants reported that staff buy-in was necessary, whereas having a multidisciplinary team with good communication among team members was reported as helpful by 90% of participants. The most common barrier reported was increased staff workload (80%). All participants (100%) noted improved patient outcomes as an important benefit, and 95% reported improved job satisfaction.
  
  
  CONCLUSIONS
  This qualitative study of a successful early rehabilitation program highlights the importance of assessing and engaging a multidisciplinary team before implementation and the positive outcomes of early rehabilitation on staff by improving job satisfaction and changing the culture of a hospital unit.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA. Electronic address: Meakin1@jhmi.edu.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Eakin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Ugbah
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Arnautovic
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Parker
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D016638:Critical Illness / Q000534:rehabilitation*; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016730:Program Development; D036301:Qualitative Research; D016526:Workload
keywords: Early rehabilitation; Implementation; Intensive care; Sedation