Early Mobilisation in Paediatric Intensive Care: does routine patient screening reduce time to mobilisation?

Muir, C.1, Esterman, A. 2, Ganu, S. 1, Maki, K. 1, Keeley, S. 1, Ward, E. 2, Allen, K. 1 & Tsiros, M.2

1Women’s and Children’s Health Network, SA Health, 2 University of South Australia

 

Background: Early mobilisation (EM) has been demonstrated to improve outcomes in adults post Intensive Care Unit (ICU) admission; however, the culture of Paediatric Intensive Care Units (PICU) is frequently focused around immobility due to fears for patient safety. This study examines whether routine patient screening by medical staff with an “EM Screening Checklist” reduces time to mobilisation.

Methods: A historical control study was conducted in the PICU of an Australian tertiary, teaching, public hospital. Baseline data on time to mobilisation and patient characteristics was collected by case note audit for all patients admitted over a 5-month period in 2018 (n=36). Corresponding data were collected with the intervention group (n=36) over a 5-month time period in 2019 following the implementation of the “EM Screening Checklist”. Survival analysis was used to compare time to mobilisation for each group.

Results: Cox regression demonstrated the intervention group were 1.3 times more likely to receive mobilisation (p=0.332). Subjects with a past medical history of motor impairment had a hazard ratio of 0.62, and thus were 38% less likely to be mobilised (p=0.113). Subjects who received mechanical ventilation were 44% less likely to be mobilised (p=0.033). There were no adverse events.

Conclusions: Whilst analysis demonstrated reduction in time to mobilisation this was not statistically significant. This may be due to the small sample size, or the number of lower acuity subjects diluting the sample. The identification of groups less likely to receive mobilisation interventions will help to inform future direction of clinical services. The absence of any adverse events suggests that EM in PICU is safe.


Catherine Muir

Catherine is Senior Physiotherapist, Paediatric Intensive Care Unit for the Women’s and Children’s Health Network. She has a special interest in early mobilisation and developmental care in Paediatric Intensive Care. In 2018, Catherine presented at Australia New Zealand Intensive Care Society ASM on Barriers to Early Mobilisation in Paediatric Intensive Care. Catherine was a recipient of a 2019 UniSA/SA Health Research Collaboration Grant for the project Early Mobilisation in Paediatric Intensive Care: A Safety and Quality Intervention.

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