Improving Outcomes for Critically Ill Cardiovascular Patients through Increased Physical Therapy Staffing

Publication date: Available online 30 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Joshua K. Johnson, Bryan Lohse, Haley A. Bento, Christopher S. Noren, Robin L. Marcus, Joseph E. Tonna

ABSTRACT

Objective

To examine the effect of increasing physical therapy staff in a cardiovascular ICU (CVICU) on temporal measures of physical therapy 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 six-month quality improvement initiative increased CVICU-dedicated physical therapy staff from two to four.

Main Outcome Measures

Changes in physical therapy delivery were examined using the frequency and daily duration of physical therapy 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 physical therapy 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 physical therapy staff was associated with increased physical therapy treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors.

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