ICU Mobility Program Saves $500K in 6 Months

A program to get mechanically ventilated and post-operative ICU patients up and moving quickly represented a huge culture change for nurses, but it reduced length of stay and eliminated pressure ulcers and ventilator-associated pneumonia.

A nurse-driven ambulatory initiative at Duke Raleigh Hospital's ICU saved $589,824 over six months, and is projected to save nearly $1.2 million over a year.

The whole thing kicked off with bingo, trivia, t-shirts, and lots of food at a two-day event last April.

That event ushered in the ICU's six-month early progressive mobility (EPM) program that was made possible by a $10,000 grant from American Association of Critical-Care Nurses' Clinical Scene Investigator Academy. The AACN CSI Academy aims to "empower bedside nurses as clinician leaders and change agents" through programs that are developed and implemented by nursing teams, according to AACN.

Duke Raleigh's EPM work aimed to get mechanically ventilated and post-operative patients up and moving sooner, sometimes as soon as they're admitted to the ICU, in an effort to decrease the cost and length of stay as well days on mechanical ventilator.

Research has shown that getting ICU patients moving sooner can also reduce the amount of muscle wasting and infections, says Kristin Merritt, MSN, MBA, RN, NE-BC, CCRN, ICU neuroscience nurse manager at Duke Raleigh.

Although the evidence supporting EPM among ICU patients is compelling, Merritt says it represented a huge culture change for nurses who needed to take an hour or more out of their days to get patients up and moving.

"It just wasn't built into their day. It is time consuming," she says. "It just really changes how they have to structure their day. Their time management had to change."

And getting beside nurses onboard with making such a huge change took a lot of work even before the initiative began.

The kick-off event itself included a PowerPoint presentation featuring data and research supporting early progressive mobility, as well as objectives of the new program at Duke Raleigh.

And it wasn't just the nurses who were involved in the kick-off; the physician team, surgeons, rehabilitation services, the executive leadership team, and all the ICU staff participated, too, Merritt says.

"We invited the hospital because we wanted this to be an initiative that everyone learned about because it eventually goes past the intensive care unit walls," she says.

The kick-off event was just the first step. Seeing the real results of the program—included enthusiasm from patients and families—helped motivate the nurses, too. "They were very proud," says Mimi Matthys, RN, MSN, clinical team lead in the ICU. "They saw their patient get better and that's all they needed."

Elements of the initiative included:

• Screening patients every 12 hours for whether it was safe for them to be part of the program
• Conducting regular audits to see whether the screenings were happening; tracking which patients sat at the edge of the bed, sat in a chair, ambulated
• Creating a brochure about the program that's given to families at admission
• Posting "mile markers" around the unit so patients could see how far they'd walked
• Awarding gold medals to patients who walked the entire unit; and
  posting staff reward boards with prizes

Matthys says having the entire unit involved in the initiative showed that there is strength in numbers.

"Other staff couldn't ignore it. This was serious, this was a big deal," she says. Also, the nurses involved in the program found that getting patients up and moving took fewer people and less time than they initially thought it would. It also got easier with practice.

The program's six-month results were impressive. In addition to the half million dollars in savings, there were some remarkable patient outcomes, too.

"We did not have any pressure ulcers, no patient falls, and no ventilator-associated pneumonia," says Merritt. "Sometimes in an ICU those kinds of measures are just kind of unheard of."

Merritt adds that one "unexpected" outcome was that the ICU's HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores improved, too. Patients and families really liked the program and responded well to it, she says.

Also, the unit's "communication skills became better because it was at the forefront for always talking with patients and families," Merritt says.

Now, the initiative is permanent, and as of February 8, early progressive mobility is protocol is throughout the Duke Raleigh ICU. That's a long way from a bingo game.