Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on “Rehabilitation 2030” in Brazil

Abstract

Objective

To investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil.

Design

This is a retrospective cohort study.

Setting

A Brazilian educational and research-intensive care unit (ICU).

Participants

A total of 1047 patients were hospitalized from May 2016 to April 2018.

Interventions

Implementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP).

Main Outcome Measures

Clinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP.

Results

There was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40).

Conclusions

Early mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.