Quality Improvement Process Benefits ICU Patients

Team approach reduces sedation, promotes early physical medicine and rehabilitation

FRIDAY, April 16 (HealthDay News) -- In patients with acute respiratory failure who are in intensive care, implementation of a quality improvement process involving a multidisciplinary team is associated with significant improvements in intensive care unit delirium, physical rehabilitation and functional mobility, and a decreased length of stay, according to a study published in the April issue of the Archives of Physical Medicine and Rehabilitation.

Dale M. Needham, M.D., of Johns Hopkins University in Baltimore, and colleagues studied 57 patients who were mechanically ventilated for four days or longer. A multidisciplinary team focused on reducing heavy sedation and increasing staffing to include full-time occupational and physical therapists.

After implementation of the quality improvement process, the researchers found that the proportion of medical intensive care unit days that patients received benzodiazepines declined from 50 to 25 percent. They also observed that the intervention was associated with lower median daily sedative doses, improved sedation and delirium status, a higher median number of rehabilitation treatments per patient (one versus seven), a higher level of functional mobility, and a decrease in intensive care unit and hospital length of stay of 2.1 and 3.1 days, respectively.

"Given the benefits demonstrated from this project, the hospital funded a new Critical Care Physical Medicine and Rehabilitation program, which allowed the multidisciplinary team assembled during the quality improvement project to be sustained," the authors write. "This new program is seeking means of solidifying the gains from the existing quality improvement process and investigating new ways of achieving further improvement for early physical medicine and rehabilitation."

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