title: PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children.
abstract: To determine the safety and feasibility of an early mobilization program in a PICU.
  
  
  
  Observational, pre-post design.
  
  
  
  PICU in a tertiary academic hospital in the United States.
  
  
  
  Critically ill pediatric patients admitted to the PICU.
  
  
  
  This quality improvement project involved a usual-care baseline phase, followed by a quality improvement phase that implemented a multicomponent, interdisciplinary, and tiered activity plan to promote early mobilization of critically ill children.
  
  
  
  Data were collected and analyzed from July to August 2014 (preimplementation phase) and July to August 2015 (postimplementation). The study sample included 200 children 1 day through 17 years old who were admitted to the PICU and had a length of stay of at least 3 days. PICU Up! implementation led to an increase in occupational therapy consultations (44% vs 59%; p = 0.034) and physical therapy consultations (54% vs 66%; p = 0.08) by PICU day 3. The median number of mobilizations per patient by PICU day 3 increased from 3 to 6 (p < 0.001). More children engaged in mobilization activities after the PICU Up! intervention by PICU day 3, including active bed positioning (p < 0.001), and ambulation (p = 0.04). No adverse events occurred as a result of early mobilization activities. The most commonly reported barriers to early mobilization after PICU Up! implementation was availability of appropriate equipment. The program was positively received by PICU staff.
  
  
  
  Implementation of a structured and stratified early mobilization program in the PICU was feasible and resulted in no adverse events. PICU Up! increased physical therapy and occupational therapy involvement in the children's care and increased early mobilization activities, including ambulation. A bundled intervention to create a healing environment in the PICU with structured activity may have benefits for short- and long-term outcomes of critically ill children.
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.2Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.3Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.4Department of Child Life, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.5University of Maryland School of Nursing, Baltimore, MD.6Pediatrix Medical Group, Herman-Walter Samuelson Children's Hospital at Sinai, Baltimore, MD.7Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.8Interactive Learning, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Beth
authors.initials: B
authors.lastname: Wieczorek
authors.forename: Judith
authors.initials: J
authors.lastname: Ascenzi
authors.forename: Yun
authors.initials: Y
authors.lastname: Kim
authors.forename: Hallie
authors.initials: H
authors.lastname: Lenker
authors.forename: Caroline
authors.initials: C
authors.lastname: Potter
authors.forename: Nehal J
authors.initials: NJ
authors.lastname: Shata
authors.forename: Lauren
authors.initials: L
authors.lastname: Mitchell
authors.forename: Catherine
authors.initials: C
authors.lastname: Haut
authors.forename: Ivor
authors.initials: I
authors.lastname: Berkowitz
authors.forename: Frank
authors.initials: F
authors.lastname: Pidcock
authors.forename: Jeannine
authors.initials: J
authors.lastname: Hoch
authors.forename: Connie
authors.initials: C
authors.lastname: Malamed
authors.forename: Tamara
authors.initials: T
authors.lastname: Kravitz
authors.forename: Sapna R
authors.initials: SR
authors.lastname: Kudchadkar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness; D004434:Early Ambulation / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies