May 14, 2018
Researchers from Johns Hopkins and the Kennedy Krieger Institute are investigating whether earlier transfers to rehabilitation from the pediatric intensive care unit lead to pediatric patients returning home sooner. Above, occupational therapist Yun Kim helps a patient improve fine motor skills.
Over the last decade, Johns Hopkins researchers have found that patients in the adult intensive care unit benefit from increased activity and mobility. Getting patients up and moving sooner leads to shorter lengths of stay, fewer readmissions and improved patient outcomes. Now, researchers want to find out if the same applies to patients in the pediatric intensive care unit (PICU).
“If these patients receive rehabilitation services early on during their PICU admission when their medical status has stabilized, we believe that a more successful transition to their next phase of recovery in an inpatient rehab unit has the potential to improve their eventual outcome,” says Frank Pidcock, director of pediatric rehabilitation in the Johns Hopkins Department of Physical Medicine and Rehabilitation and vice president of rehabilitation at the Kennedy Krieger Institute. “Incorporating therapy services that are sensitive to neurorecovery at the PICU bedside, especially for patients with brain disorders, may shorten PICU length of stay and result in earlier implementation of therapies in a rehabilitation setting.”
This investigation began as a quality improvement project at Johns Hopkins Children’s Center led by Beth Wieczorek, manager of nurse practitioners, and Sapna Kudchadkar, pediatric critical care medicine physician, with Pidcock’s collaboration. The goal was to increase the amount of early mobilization activities as well as the involvement of physical and occupational therapists with patients who had a stay of at least three days in the PICU.
Over the course of the one-year initiative, occupational therapy consultations increased by 15 percent and physical therapy consultations grew by 12 percent by the patients’ third day in the PICU. The average number of mobilizations doubled from three to six per day per patient, including active bed positioning and ambulation. Most importantly, there were no adverse events associated with early mobilization. The results were published in December 2016 in Pediatric Critical Care Medicine.
Upon completion of the pilot project, clinicians implemented the practices as standard procedure in the Johns Hopkins PICU. An important unanswered question is whether early mobilization in the PICU can affect the short- and long-term functional outcomes in critically ill children.