A recent Johns Hopkins study suggests that timely initiation of physical therapy in the intensive care (ICU) unit improved outcomes through structured quality improvement processes. A university news release notes that during a pre- and post-evaluation study, researchers found that quality improvement processes for delivering physical rehabilitation in an ICU were sustained 5 years later, providing benefits to both patients and the healthcare facility. The release adds that the processes yielded major changes in clinical practices for treating critically ill patients by encouraging early physical therapy in the ICU.

Dale M. Needham, MD, PhD, medical director of the Critical Care Physical Medicine and Rehabilitation Program at Johns Hopkins and senior author, explains that researchers know the early start of physical rehabilitation in the ICU improves patient outcomes. However, “In this study, we wanted to evaluate whether our quality improvement project had a lasting effect on the early delivery of rehabilitation in the ICU.”

While working in a single medical ICU at Johns Hopkins, the release says Needham and his team collaborated with hospital staff and administrators to promote the sustainability of their quality improvement project, including the removal of barriers, further interdisciplinary education and communication, and the continued participation of more than 20 physical therapists who worked in the medical ICU after the quality improvement period.

Needham points out that none of the results “happened by accident,” and adds that if hospitals use a structured approach to creating this change, they could achieve this success as well.

Needham’s structured approach included making the business case to hospital administrators that investing in early rehabilitation programs could improve patient outcomes while also reducing hospital costs, since these patients had shorter lengths of stay.

The release reports that in order to quantify the lasting effects of their quality improvement project, Needham’s team compared data that had been collected from a prospective cohort study (pre-quality improvement) with data collected beginning a year after starting the quality improvement project  (post-quality improvement). The release adds that patients in both the pre- and post-quality groups had acute respiratory distress syndrome.

Needham says the researchers saw dramatic changes after the quality improvement project compared to before the project. According to the release, among ICU survivors, a higher proportion of patients received physical therapy in the ICU, with 89% post-quality improvement compared to 24% pre-quality improvement. Additionally, there were fewer days before starting physical therapy in the ICU; a median of 4 days post-quality improvement compared to 12 days pre-quality improvement.

The team also sought to investigate the functional abilities of the patients, such as whether they were able to stand or walk while in the ICU. The team states that 64% of post-quality improvement patients could stand or walk, compared to 7% of patients before the quality improvement project.

The release notes that as a result of advances in critical care and the aging population, there is now a growing pool of ICU survivors who may sustain physical impairments for years post-ICU. These patients may ultimately delay returning to work and may utilize the healthcare system more.

“The key to addressing these issues is to start rehabilitation early,” says Needham, which requires sustainably changing the culture in ICUs.

[Source: Johns Hopkins Medicine]