Hospitals in pursuit of excellence

Walking the Walk: A Progressive Mobility Protocol in a Cardiovascular Surgical Intensive Care Unit Improves Patient Perception and Results in Lower Costs Through Decreased Ventilator Hours and Length of Stay

Early and safe mobility of critically ill patients in a cardiovascular surgical intensive care unit was addressed in this study. Using a multilevel mobility protocol, the team aimed to decrease the CVICU length of stay, decrease ventilator hours and evaluate the patients’ experience of care related to mobility.

FOCUS-PDSA was used to develop a mobility protocol for use within the patients’ acute care environment. Their perception of mobility was measured in three phases using a visual analog scale.

The mobility protocol included bed and transfer activities and ambulation. Patients reported a significant improvement in their perception of mobility during their CVICU length of stay. The mean number of ventilator hours decreased from 63 hours to 35 hours. CVICU length of stay decreased in three of four surgical categories; the largest decrease (10.8 CVICU days) experienced by ventricular-assist device patients.

The CVICU group experienced zero falls, an overall decrease in the pressure ulcer occurrence rate and no loss of lines, drains or endotracheal tubes during mobility.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)