Sustained Three-Year Impact of a Physical Therapy Quality Improvement Project in the Medical Intensive Care Unit

IMPORTANCE: Early rehabilitation and mobility are components of care bundles and clinical practice guidelines for patients who are critically ill. Improved delivery of physical therapy is associated with decreased intensive care unit (ICU) length of stay (LOS). Barriers exist to optimizing the delivery of physical therapy. Analyses of quality improvement (QI) are often narrow in scope. Care improvements may not persist. Opportunities remain to improve physical therapy delivery to patients in the medical ICU (MICU) while analyzing care delivery and ICU LOS. OBJECTIVE: The objective was to determine whether a QI initiative sustained improvement in physical therapy delivery and associations with ICU LOS in the MICU. DESIGN: This was a before-during-after comparative design. SETTING: The study took place in the MICU at a quaternary, academic medical center. PARTICIPANTS: The study included 13,058 MICU admissions. INTERVENTION(S): The intervention was a multifaceted physical therapy program including multidisciplinary education, physical therapists integrated into multidisciplinary rounds, automatic physical therapist consult orders, electronic health record (EHR) hard stop for bedrest orders, and increased physical therapy staffing including a program coordinator physical therapist. MAIN OUTCOME(S): Our primary outcomes were delivery, timing, and frequency of physical therapy, as well as ICU LOS. MEASURE(S): Main outcomes were assessed by (1) odds of receiving physical therapy while in the MICU and (2) time from MICU admission to first physical therapist session and (3) ICU LOS. RESULTS: During the intervention, an increased proportion of admits received physical therapy with a nearly 4-fold increase in the odds of receiving physical therapy. Time to first physical therapist session was decreased while the proportion of days with physical therapy in the ICU was increased. In adjusted analysis, ICU LOS decreased modestly. Findings were similar for 3 years post-QI. CONCLUSIONS: Despite variable resources and increased illness severity in the post-intervention period, durable improvements in the percentage of patients receiving physical therapy, odds of receiving physical therapy, time to physical therapy, and proportion of days with physical therapy occurred for 3 years post-QI. Secondarily, the during and post periods were associated with modest reductions in ICU LOS. RELEVANCE: This work is applicable to the fields of: critical care rehabilitation, quality improvement, ICU mobility, and health care delivery.