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.
Keywords: delirium; early mobility; occupational therapy; pediatric oncology; physical therapy; post-intensive care syndrome; quality improvement.
Copyright © 2021 Ghafoor, Fan, Williams, Brown, Bowman, Pettit, Gorantla, Quillivan, Schwartzberg, Curry, Parkhurst, James, Smith, Canavera, Elliott, Frett, Trone, Butrum-Sullivan, Barger, Lorino, Mazur, Dodson, Melancon, Hall, Rains, Avent, Burlison, Wang, Pan, Lenk, Morrison and Kudchadkar.