The Up! Early Progressive Mobility Pathway

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Traditionally, mobility of Intensive Care Unit (ICU) patients was considered unsafe due to a multitude of tubes, catheters, and monitoring devices. But current research has indicated that early mobilization provides many benefits to patients, including decreased length of stay, reduced number of days on a ventilator, and improved muscle strength and function.

Clinicians in the Vancouver General Hospital (VGH) ICU noted that patient mobilization was often delayed or provided towards the end of the ICU stay, due to worries about safety and stability. The delays can increase the chance that a patient will experience complications related to immobility, such as delirium, and neuromuscular weakness, or decreased quality of life. With more than 1300 admissions per year, the VGH ICU had the potential to impact a significant number of patients through promoting early mobilization of patients.

In response, the project team has focused on changing the culture of the ICU to better align with current research and best practices. The team used the 4E’s framework for knowledge translation (Engage, Educate, Execute and Evaluate) to design a quality improvement initiative and to create a cultural shift toward early mobilization of ICU patients, named Up! Early Progressive Mobility Pathway, which launched in January 2014.

As a result of the initiative, all ICU patients are assessed with the early mobility pathway, which addresses’ the patient’s mobility needs in a safe and efficient manner throughout their stay. The pathway has six stages, progressing from simple bed rest to bed exercises and all the way to independent walking (stage 6). At each stage specific inclusion and exclusion criteria allow clinicians to use their judgment and expertise to determine the safest, most beneficial plan of care for each patient.

Between January 2014 and March 2015, more than 1400 patients have been mobilized through Up! While 69% of ICU patients are on bedrest on day 2 following admission, this figure drops significantly to 39% of patients by day 7. And only 21 adverse events have been reported, demonstrating the safety and feasibility of the Pathway. It continues to be the standard of care for all VGH ICU patients.

Up! breaks free from tradition and is an example of the unit’s commitment to clinical leadership and excellence in patient care, empowering clinicians with knowledge and abilities to provide excellent, evidence-based mobility interventions. It has demonstrated that early mobility is safe, feasible and beneficial in complex ICU patients. Successes and lessons learned from this quality initiative can and will be shared among the critical care community in British Columbia.

The UP! team plans to put its $2,500 toward future education days, mobilization equipment, and to develop resources to continue to promote early mobilization of ICU patients not just in VGH, but also across Vancouver Coastal Health through its Regional Critical Care Council.