title: An Environmental Scan for Early Mobilization Practices in U.S. ICUs.
abstract: OBJECTIVE
  Early mobilization improves patient outcomes. However, diffusion of this intervention into standard ICU practice is unknown. Dissemination and implementation efforts may be guided by an environmental scan to detail readiness for early mobilization, current practice, and barriers to early mobilization.
  
  
  METHODS
  A telephone survey.
  
  
  METHODS
  U.S. ICUs.
  
  
  METHODS
  Five hundred randomly selected U.S. ICUs stratified by regional hospital density and hospital size.
  
  
  METHODS
  None.
  
  
  RESULTS
  We surveyed 687 ICUs for a 73% response rate (500 ICUs); 99% of respondents were nursing leadership. Fifty-one percent of hospitals reported an academic affiliation. Surveyed ICUs were most often mixed medical/surgical (58%) or medical (22%) with a median of 16 beds (12-24). Thirty-four percent reported presence of a dedicated physical and/or occupational therapy team for the ICU. Overall, 45% of ICUs reported early mobilization practice; two thirds of ICUs with early mobilization practice reported using a written early mobilization protocol. In ICUs with early mobilization practice, 52% began the intervention at admission and 74% enacted early mobilization for both ventilated and nonventilated patients. Early mobilization was provided a median of 6 days per week, twice daily. Factors independently associated with early mobilization protocols include dedicated physical/occupational therapy (odds ratio, 3.34; 95% CI, 2.13-5.22; p<0.01), American Hospital Association region 2 (odds ratio, 3.33; 95% CI, 1.04-10.64; p=0.04), written sedation protocol (odds ratio, 2.36; 95% CI, 1.25-4.45; p<0.01), daily multidisciplinary rounds (odds ratio, 2.31; 95% CI, 1.29-4.15; p<0.01), and written daily goals for patients (odds ratio, 2.17; 95% CI, 1.02-4.64; p=0.04). Commonly cited barriers included equipment, staffing, patient and caregiver safety, and competing priorities. In ICUs without early mobilization adoption, 78% have considered implementation but cite barriers including competing priorities and need for further planning.
  
  
  CONCLUSIONS
  Diffusion regarding benefits of early mobilization has occurred, but adoption into practice is lagging. Mandates for multidisciplinary rounds and formal sedation protocols may be necessary strategies to increase the likelihood of successful early mobilization implementation. Methods to accurately assess and compare institutional performance via practice audit are needed.
authors: 1Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC. 2Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, NC. 3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. 4Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. 5Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania, Philadelphia, PA. 6Clinical Specialist Physiotherapist in Critical Care, Queen Elizabeth Hospital, Birmingham, United Kingdom. 7University of Utah College of Nursing, Salt Lake City, UT. 8Institute for Healthcare Improvement, Adult ICU Faculty, Cambridge, MA. 9Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA.
authors: Rita N
authors: RN
authors: Bakhru
authors: Douglas J
authors: DJ
authors: Wiebe
authors: David J
authors: DJ
authors: McWilliams
authors: Vicki J
authors: VJ
authors: Spuhler
authors: William D
authors: WD
authors: Schweickert
mesh_terms: D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D004777:Environment; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009788:Occupational Therapy / Q000458:organization & administration; D016017:Odds Ratio; D026741:Physical Therapy Modalities; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States