Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit

Saad Ghafoor, Kimberly Fan, Sarah Williams, Amanda Brown, Sarah Bowman, Kenneth L. Pettit, Shilpa Gorantla, Rebecca Quillivan, Sarah Schwartzberg, Amanda Curry, Lucy Parkhurst, Marshay James, Jennifer Smith, Kristin Canavera, Andrew Elliott, Michael Frett, Deni Trone, Jacqueline Butrum-Sullivan, Cynthia Barger, Mary LorinoJennifer Mazur, Mandi Dodson, Morgan Melancon, Leigh Anne Hall, Jason Rains, Yvonne Avent, Jonathan Burlison, Fang Wang, Haitao Pan, Mary Anne Lenk, R. Ray Morrison, Sapna R. Kudchadkar

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. Methods: We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. Results: Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff. Conclusions: Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.

Original languageEnglish (US)
Article number645716
JournalFrontiers in Oncology
Volume11
DOIs
StatePublished - Mar 8 2021

Keywords

  • delirium
  • early mobility
  • occupational therapy
  • pediatric oncology
  • physical therapy
  • post-intensive care syndrome
  • quality improvement

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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