Abstract
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.
Keywords
List of abbreviations:
AM-PAC (Activity Measure for Postacute Care), APACHE (Acute Physiology and Chronic Health Evaluation), CCI (Charlson comorbidity index), CRRT (continuous renal replacement therapy), CVICU (cardiovascular intensive care unit), EDW (enterprise data warehouse), ICU (intensive care unit), LOS (length of stay), MCS (mechanical circulatory support), MV (mechanical ventilation), PT (physical therapy), QI (quality improvement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 30, 2018
Footnotes
Supported in part by the Foundation for Physical Therapy and the University of Utah Population Health Research Foundation, United States, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant no. 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764). Neither funding agency played any role in the conduct or report of this study.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
