Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on “Rehabilitation 2030” in Brazil

Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on “Rehabilitation 2030” in Brazil

To investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil. This is a retrospective cohort study. A Brazilian educational and research-intensive care unit (ICU). A total of 1047 patients were hospitalized from May 2016 to April 2...

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Published in:Archives of physical medicine and rehabilitation
Main Authors: Biazon, Thaís Marina Pires de Campos, Pott Jr, Henrique, Caruso, Flávia Cristina Rossi, Bonjorno Jr, José Carlos, Castello-Simões, Viviane, Lazzarini, Maria Thereza Bugalho, Taconelli, Mariana, Borghi-Silva, Audrey, Mendes, Renata Gonçalves
Format: Journal Article
Language:English
Published: United States Elsevier Inc 31-08-2024
Subjects:
Early multiprofessional mobilization
Intensive care
Lower middle-income countries
Quality indicators
Rehabilitation
Intensive care
SBT
CI
Lower middle-income countries
Quality indicators
CCI
EM
RASS
STROBE
APACHE II
STP
MMS
IMV
MCID
Early multiprofessional mobilization
ICU
Rehabilitation
MAP
WHO
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Summary:To investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil. This is a retrospective cohort study. A Brazilian educational and research-intensive care unit (ICU). A total of 1047 patients were hospitalized from May 2016 to April 2018. Implementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP). Clinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP. There was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40). Early mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.
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ISSN:0003-9993
1532-821X
1532-821X
DOI:10.1016/j.apmr.2024.08.010