A human factors analysis of missed mobilisation after discharge from intensive care: a competition for care?
O D Gustafson, S Vollam, L Morgan and 1 others
PMID 34571285WHAT IT FOUND
Ward therapy planning prioritised patients nearing discharge, so post-ICU mobilisation was delayed or less frequent.
Staff shortages, equipment problems and patients unable to stand and step to a chair made sitting out less likely.
Key findings
01The analysis found that the physiotherapy day plan was shaped by organisational pressure to expedite discharge, directing therapy resource towards patients needing intervention to leave hospital and away from post-ICU mobilisation.
02The analysis found that post-ICU patients with ongoing rehabilitation needs were down-prioritised, which could move mobilisation later in the day or mean it did not happen every day.
03The analysis found that patients unable to stand and step to a chair were less likely to be mobilised, and lack of staff or equipment led to reduced interventions such as sitting on the edge of the bed and returning to bed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only a small group of staff took part, so the findings may not cover all ward contexts. The study aimed to explore processes involved in post-ICU mobilisation to inform future service improvement, not to test an intervention. It did not analyse weekend care or other sub-optimal scenarios in depth. The FRAM model describes work as done but does not explore the wider implications of making changes based on its results. Some primary data that informed the discussion is intended for publication elsewhere, so the full patient and staff experience data are not reported here.
The easy way to misread this
Do not read this as proof that changing the physiotherapy day plan will improve mobilisation. It is a small qualitative focus group analysis, not a trial of patient outcomes.