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

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...

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Published in:	Frontiers in oncology Vol. 11; p. 645716
Main Authors:	Ghafoor, Saad, Fan, Kimberly, Williams, Sarah, Brown, Amanda, Bowman, Sarah, Pettit, Kenneth L, Gorantla, Shilpa, Quillivan, Rebecca, Schwartzberg, Sarah, Curry, Amanda, Parkhurst, Lucy, James, Marshay, Smith, Jennifer, Canavera, Kristin, Elliott, Andrew, Frett, Michael, Trone, Deni, Butrum-Sullivan, Jacqueline, Barger, Cynthia, Lorino, Mary, Mazur, Jennifer, Dodson, Mandi, Melancon, Morgan, Hall, Leigh Anne, Rains, Jason, Avent, Yvonne, Burlison, Jonathan, Wang, Fang, Pan, Haitao, Lenk, Mary Anne, Morrison, R Ray, Kudchadkar, Sapna R
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 08-03-2021
Subjects:	delirium early mobility occupational therapy Oncology pediatric oncology physical therapy post-intensive care syndrome early mobility pediatric oncology quality improvement post-intensive care syndrome physical therapy delirium occupational therapy
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Summary:	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. 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. 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% ( <0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% ( =0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% ( =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. 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.
Bibliography:	Reviewed by: Linette Ewing, University of Texas MD Anderson Cancer Center, United States; Veronika Polishchuk, Nationwide Children’s Hospital, United States This article was submitted to Pediatric Oncology, a section of the journal Frontiers in Oncology Edited by: Kris Michael Mahadeo, University of Texas MD Anderson Cancer Center, United States
ISSN:	2234-943X 2234-943X
DOI:	10.3389/fonc.2021.645716