Introducing early and structured rehabilitation in critical care: A quality improvement project.


Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom. Electronic address: [Email]


OBJECTIVE : To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation.
METHODS : Fifteen-month prospective before/after quality improvement project.
METHODS : Seven-bed mixed dependency critical care unit.
METHODS : 209 patients admitted to critical care for ≥4 days.
METHODS : A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care.
METHODS : Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care.
RESULTS : Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019).
CONCLUSIONS : The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.


Critical care,ICU,Implementation,Physiotherapy,Quality improvement,Rehabilitation,