In a recent post So, you think you can walk? I outlined some of the evidence, rationale, logic, and decision making involved in acute care physical therapist practice. I discussed the important of conceptualizing and studying physical therapists impact “beyond function.”
An article from UPI.com entitled Providing Physical Therapy in ICU Helpful highlights exactly this concept. The study discussed will be published around March in Critical Care Medicine. An e-published ahead of print version is already available: ICU Physical Rehabilitation Programs: Financial Modeling of Cost Savings. The benefits of technology allow us to begin preliminary discussion and analysis!
The authors modeled cost savings utilizing best-case and most conservative estimates of length of stay reductions, upfront costs, and other factors based on existing published data and their specific quality improvement project. The quality improvement project undertaken at Johns Hopkins University within the medical ICU included full time, dedicated physical therapists and occupational therapists in the medical ICU. The vision:
A multidisciplinary team focused on reducing heavy sedation and increasing MICU staffing to include full-time physical and occupational therapists with new consultation guidelines.
In total, the early rehabilitation program cost the hospital approximately $358,00 more per year than the previous standard of care. So, what did the results say? Within 1 year, ICU length of stay decreased by an average of 23% while medical ICU admissions increased by over 20%. An $818,000 per year net savings after accounting for start up costs (approximately $358,000) was observed. Conclusions:
A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.
The “actual experience” investigation is actually published in Archives of Physical Medicine and Rehabilitation: Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. The study lead, Dr. Dale Needham, MD, PhD, passionately advocates for the importance and necessity of physical therapists and early mobility within ICU’s for individuals with critical illness. Independently, the results of that quality improvement study are also profound:
Results: Compared with before the quality improvement project, benzodiazepine use decreased markedly (proportion of MICU days that patients received benzodiazepines [50% vs 25%, P=.002]), with lower median daily sedative doses (47 vs 15 mg midazolam equivalents [P=.09] and 71 vs 24 mg morphine equivalents [P=.01]). Patients had improved sedation and delirium status (MICU days alert [30% vs 67%, P<.001] and not delirious [21% vs 53%, P=.003]). There were a greater median number of rehabilitation treatments per patient (1 vs 7, P<.001) with a higher level of functional mobility (treatments involving sitting or greater mobility, 56% vs 78%, P=.03). Hospital administrative data demonstrated that across all MICU patients, there was a decrease in intensive care unit and hospital length of stay by 2.1 (95% confidence interval: 0.4-3.8) and 3.1 (0.3-5.9) days, respectively, and a 20% increase in MICU admissions compared with the same period in the prior year.
Conclusions: Using a quality improvement process, intensive care unit delirium, physical rehabilitation, and functional mobility were markedly improved and associated with decreased length of stay.
- Early mobility in acute care. It’s important.
- The physical therapist in acute care. A vital part of the care team.
- Looking beyond function to conceptualize and understand the impact of the physical therapist? Necessary.
Resources:
1. Dale Needham, MD, PhD Publications via PubMed
2. Issues Affecting the Delivery of Physical Therapy Services for Individuals With Critical Illness
3. ICU Early Physical Rehabilitation Programs: Financial Modeling of Cost Savings
4. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project
5. Rehab in the ICU: Johns Hopkins Critical Care Physical Medicine and Rehab Program
6. Clinical Programs and Quality Improvement
Similar summary from Science Daily: http://www.sciencedaily.com/releases/2013/01/130111143824.htm
Great summary, as usual. I really applaud the whole Hopkins team for publishing and sharing their results. I know many hospitals and hospital systems conduct similar quality improvement projects, many of which show the value of physical therapy in the acute/critically ill patient/setting, but do not go that extra step to disseminate their results. I understand it is considered the role of academic medical centers, like Hopkins, to do this but this cuts both ways. It makes it easy for community medical centers to discount findings (“they can do it at their institution, but it would never work here”) or to claim they are outliers (“it was that one ICU/hospital”). Kudos for going the extra step. Now, I’m challenging all you practicing in acute and critical care–what are you doing that could benefit your colleagues? How are you sharing that information or those findings? What collaboration can you form to get out the news about acute care physical therapy?