Improving Outcomes for Critically Ill Cardiovascular Patients Through Increased Physical Therapy Staffing.

Publisher: W.B. Saunders Country of Publication: United States NLM ID: 2985158R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-821X (Electronic) Linking ISSN: 00039993 NLM ISO Abbreviation: Arch Phys Med Rehabil Subsets: MEDLINE

Original Publication: Philadelphia, PA : W.B. Saunders

Cardiac Rehabilitation/*methods ; Critical Illness/*rehabilitation ; Intensive Care Units/*organization & administration ; Personnel Staffing and Scheduling/*organization & administration ; Physical Therapy Department, Hospital/*organization & administration; APACHE ; Academic Medical Centers ; Adult ; Aged ; Disability Evaluation ; Early Ambulation/methods ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Physical Therapy Modalities ; Quality Improvement/organization & administration ; Renal Replacement Therapy/methods ; Respiration, Artificial ; Retrospective Studies ; Workforce/organization & administration

Objective: To examine the effect of increasing physical therapy (PT) staff in a cardiovascular intensive care unit (CVICU) on temporal measures of PT interventions and on outcomes important to patients and hospitals.
Design: Retrospective pre/post subgroup analysis from a quality improvement initiative.
Setting: Academic medical center.
Participants: Cardiovascular patients in either a baseline (N=52) or quality improvement period (N=62) with a CVICU length of stay (LOS) ≥7 days and use of any one of the following: mechanical ventilation, continuous renal replacement therapy, or mechanical circulatory support.
Interventions: The 6-month quality improvement initiative increased CVICU-dedicated PT staff from 2 to 4.
Main Outcome Measures: Changes in physical therapy delivery were examined using the frequency and daily duration of PT intervention. Post-CVICU LOS was the primary outcome. CVICU LOS, mobility change, and discharge level of care were secondary outcomes. A secondary analysis of hospital survivors was also conducted.
Results: Compared to those in the baseline period, cardiovascular patients in the quality improvement period participated in PT for an additional 9.6 minutes (95% confidence interval [CI]: 1.9, 17.2) per day for all patients and 15.1 minutes (95% CI: 7.6, 22.6) for survivors. Post-CVICU LOS decreased 2.2 (95% CI: -6.0, 1.0) days for all patients and 2.6 days (95% CI: -5.3, 0.0) for survivors. CVICU LOS decreased 3.6 days (95% CI: -6.4, -0.8) for all patients and 3.1 days (95% CI: -6.4, -0.9) for survivors. Differences in mobility change and discharge level of care were not significant.
Conclusions: Additional CVICU-dedicated PT staff was associated with increased PT treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors.
(Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

BMJ. 2014 Nov 17;349:g5992. (PMID: 25403476)
Intensive Care Med. 2014 Mar;40(3):370-9. (PMID: 24257969)
South Med J. 2016 Jun;109(6):342-5. (PMID: 27255089)
Crit Care Resusc. 2009 Dec;11(4):290-300. (PMID: 20001881)
Med Care. 2008 Dec;46(12):1226-33. (PMID: 19300312)
J Crit Care. 2014 Jun;29(3):395-400. (PMID: 24508202)
Interact Cardiovasc Thorac Surg. 2016 Apr;22(4):406-10. (PMID: 26769730)
Med Care. 2004 Jan;42(1 Suppl):I49-61. (PMID: 14707755)
J Health Econ. 2005 May;24(3):465-88. (PMID: 15811539)
Arch Phys Med Rehabil. 2010 Apr;91(4):536-42. (PMID: 20382284)
Ann Epidemiol. 2007 Jan;17(1):27-35. (PMID: 17027287)
Circ Heart Fail. 2013 Sep 1;6(5):890-7. (PMID: 23926203)
Phys Ther. 2015 Oct;95(10):1335-44. (PMID: 26045604)
Phys Ther. 2014 Mar;94(3):379-91. (PMID: 24231229)
N Engl J Med. 2014 Apr 24;370(17):1626-35. (PMID: 24758618)
Lancet. 2009 May 30;373(9678):1874-82. (PMID: 19446324)
J Rehabil Med. 2007 Oct;39(8):585-90. (PMID: 17896048)
J Crit Care. 2015 Aug;30(4):664-72. (PMID: 25987293)
Respir Care. 2012 Jun;57(6):933-44; discussion 944-6. (PMID: 22663968)
Chest. 2016 Sep;150(3):722-31. (PMID: 26997241)
Crit Care Med. 2013 Jun;41(6):1543-54. (PMID: 23528802)
J Chronic Dis. 1987;40(5):373-83. (PMID: 3558716)
CMAJ Open. 2016 Aug 18;4(3):E448-E454. (PMID: 27730109)
Crit Care Med. 1985 Oct;13(10):818-29. (PMID: 3928249)
Am J Respir Crit Care Med. 2014 Jun 1;189(11):1383-94. (PMID: 24720509)
N Engl J Med. 2011 Apr 7;364(14):1293-304. (PMID: 21470008)
Intensive Care Med. 2017 Feb;43(2):171-183. (PMID: 27864615)
Surg Clin North Am. 2017 Dec;97(6):1199-1213. (PMID: 29132505)
Springerplus. 2014 Aug 20;3:445. (PMID: 25191635)
Crit Care. 2013 Feb 28;17(1):207. (PMID: 23672747)
Chest. 2017 Aug;152(2):304-311. (PMID: 28438605)
Crit Care Res Pract. 2012;2012:964547. (PMID: 23320154)
Am J Phys Med Rehabil. 2015 Apr;94(4):304-12. (PMID: 25133615)
Crit Care Med. 2009 Feb;37(2):561-6; quiz 566-8. (PMID: 19114903)
PLoS One. 2015 Jul 01;10(7):e0130722. (PMID: 26132803)
Crit Care. 2014 Dec 04;18(6):658. (PMID: 25475522)
Crit Care. 2018 Mar 20;22(1):77. (PMID: 29558969)
AACN Adv Crit Care. 2016 Apr-Jun;27(2):187-203. (PMID: 27153308)

UL1 RR025764 United States RR NCRR NIH HHS; UL1 TR000105 United States TR NCATS NIH HHS; UL1 TR001067 United States TR NCATS NIH HHS; UL1 TR002538 United States TR NCATS NIH HHS

Keywords: Administration; Critical care; Health services; Rehabilitation

Date Created: 20180903 Date Completed: 20191101 Latest Revision: 20200309

20240829

PMC6348132

10.1016/j.apmr.2018.07.437

30172645