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MICU stay becomes a moving experience for patients

It might seem counterintuitive: Getting critically ill patients to move — even walk — early during their stay on the intensive care unit.

But these patients are most in need of early mobility programs like those implemented in the medical intensive care units at both campuses. The programs' goals include maintaining patients' strength and function while they're being treated for their critical illnesses, reducing length of stay in the ICU and discharging more patients to home versus skilled nursing facilities.

"ICU patients who remain immobile can lose muscle mass, cardiac output and functional ability and are at increased risk of delirium, ventilator-associated pneumonia, falls and other significant complications," said Geoffrey Connors, MD, associate medical director, York Street Campus MICU. "These complications can persist long after discharge and reduce patients' overall mental and physical well-being."

Dr. Connors and Dawn Wicker, physical therapist, co-chaired a multidisciplinary team that, after nearly three years of planning, implemented the STEPS program in March in the YSC MICU. STEPS is an acronym representing the different types of movements patients can do.

As part of STEPS, unit-based physical and occupational therapists and a rehabilitation aide work with physicians, nurses, patient care associates, respiratory therapists and other care providers to screen patients and develop mobility programs for them.

MICU nurses at the Saint Raphael Campus are using similar techniques to get their patients moving early during their stays. Nurses began researching early mobility several years ago and customized a tool developed by the American Association of Critical-Care Nurses. The SRC nurses' original goal was to reduce the number of days patients were on ventilators, but they soon realized early mobility could also benefit non-vented patients. The SRC MICU does not have unit-based physical therapists, but nurses work closely with rehabilitation staff.

"Physical Therapy is phenomenal; they're very engaged," said Lenore Reilly, RN, patient service manager. "We all have the same goal."

STEPS and the SRC early mobility program include screening tools, staff education and regular communication among care providers about mobility. SRC MICU nurses are still collecting data, but results of a study of YSC NP 9 patients are encouraging. From May-July 2015, significantly more patients got out of bed compared to May-July 2014. In addition, ventilator use decreased by 13 percent; incidents of delirium decreased from 5 percent to zero; and median length of stay was reduced by a half a day. With these early successes and national research showing the benefits of early mobility, STEPS will be expanded to other units on both campuses.

One of the biggest benefits has as much to do with patients' outlook as outcomes. "Just walking down the hall empowers the patient; and it also empowers the staff," said Kathleen Ruotolo, RN, assistant patient service manager, York Street Campus MICU. "It's very inspiring."