Lessons Learned about the Feasibility and Effectiveness of Using Exercise Physiologists for Mobilization of Critically Ill Medical-Surgical ICU Patients

Purpose:  Describe the feasibility and effectiveness of using Exercise Physiologists in the aggressive, progressive mobilization of critically ill medical-surgical patients.

Background: Key strategies for preventing and decreasing delirium duration include early identification, modifying patient, environmental, and iatrogenic factors, and early, aggressive, mobilization that is progressive (EMAP).¹The complexity of ICU patients, which may include high levels of sedation, hemodynamic fluctuation, life support equipment and  monitoring technology are one limitation of mobilization.  Subsequently, nurse burden coupled with the scope of physical therapists’ practice and significant complex billing regulations precludes early, aggressive mobilization of critically ill patients.  Individual therapists may fear triggering a negative event when providing aggressive mobilization.  Such negative events may include unplanned extubation, cardiac arrhythmias, or oxygen desaturation. 

Methods: An interventional cohort study used the X-X Delirium Prevention Bundle© (X-X DPBundle), a prescriptive, five-component, nurse-directed bundle, in a large sample of critically ill patients (n=1032) to prevent and decrease the duration of delirium. The use of EPs is included in the EMAP component of the X-X DPBundle. The level of significance was set at 0.05, using a power of 0.80 with a moderate effect size.

Results: In a previous study researchers demonstrated that patients who mobilized were 89 times less likely to develop delirium (p=0.044); those who sat in chair were 51.4 times less likely to develop delirium (p=0.030).¹However, achieving those results required unsustainable Herculean efforts by the nursing staff. In a second study (currently under statistical analysis), Exercise Physiologists (EPs) were primarily responsible for EMAP under the direction of an RN-Delirium Coordinator and the assigned RN. During the course of the study, EPs mobilized 85% of study patients, while Physical Therapists (PTs) treated 8% of the same population. EPs collaborated to hand off the patient to PT when patients were able to take part in PT, i.e. had a billable skill. Statistical results will be available for presentation at the conference.

Conclusions: The use of Exercise Physiologists for early, aggressive, progressive mobilization in the X-X Delirium Prevention Bundle© is an effective strategy for achieving and sustaining the mobilization of critically ill medical-surgical patients. Further validation studies are planned.