Introducing early and structured rehabilitation in critical care: A quality improvement project

Objectives To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. Design Fifteen-month prospective before/after quality improvement project. Setting Seven-bed mixed dependency critical care unit. Participants 209 patients admitted to critical care for ≥4 days. Intervention A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. Main outcome measure Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. Results Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). Conclusion The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.