Tuesday, January 25, 2011

ICU Rounds Report - More evidence for early mobility

Do we need more PT? Back in October, we blogged about a cool study from the University of Pennsylvania showing the importance of early mobility and physical/occupational therapy (PT/OT). In the trial, they randomized intubated patients to nearly immediate PT versus the standard of care (wait till the tube is out). While the results were impressive (patients with early therapy were almost 3 times more like have good functional recovery, had half the delirium, spent 2.5 days less on the vent) a lot of of you (and others) raised concerns about the cost.  Certainly in our adult ICUs, PT/OT staffing is an issue.

Last week at SCCM, a large private hospital in Minnesota added some financial data to the debate. The hospital implemented a new stringent protocol where all stable ventilated patients where given aggressive PT and compared it to their historical benchmark. Prior to the protocol, 16% of intubated patients received PT rising to 45% after. Like in previous trials, benefits to patients getting early mobilization were significant (mortality dropped from 33 to 24%, delirium was halved, less sedation was used and ICU days were statistically diminished). That's not news. More importantly (to hospital administrators), mean costs per patient where reduced $6,000. In the first nine months of the protocol, the hospital saved over 2 million dollars. Is it time to add early PT/OT to the list of ICU must-haves (SBT's, sedation vacations, glycemic control, HOB elevation, etc..)?
Schweickert WD, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet 2009
Society of Critical Care Medicine (SCCM) 40th Critical Care Congress: Abstract 95. Presented January 16, 2011.

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