Key result
Multidisciplinary early mobility program cuts time to first out-of-bed mobilization ~48% after cardiac surgery.
Why the study?
Patients admitted to the CTICU following cardiac surgery were confined to bed until chest tubes were removed, which may have delayed functional independence.
Does a multidisciplinary early mobility programme reduce time to out-of-bed mobilisation and improve functional independence in patients admitted to a CTICU following cardiac surgery?
Does a multidisciplinary early mobility programme reduce time to out-of-bed mobilisation and improve functional independence in patients admitted to a CTICU following cardiac surgery?
Effect estimate: 47% reduction
Absolute Event Rate: 11.74% vs 22.77%
p-value: p=<0.005
A multidisciplinary early mobility quality improvement programme in the CTICU significantly reduced time to out-of-bed mobilisation and improved functional independence in post-cardiac surgery patients.
Supports early mobility protocols post-cardiac surgery; hypothesis-generating and requires randomized confirmation before practice change.
Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient's physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard 'run chart rules' to detect changes in outcomes over time and Welch's t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.
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Jacob et al. (2021) studied Post-cardiac surgery (n=1,320). Multidisciplinary early mobility program vs. Historical standard care (prolonged bed rest) was evaluated on Mean time to first out-of-bed mobilisation (hours) (47% reduction, p=<0.005). Implementation of a multidisciplinary early mobility program reduced the mean time to out-of-bed mobilization from 22.77 hours to 11.74 hours following cardiac surgery.
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