Improving Outcomes for Critically Ill Cardiovascular Patients Through Increased Physical Therapy Staffing.
Joshua K Johnson, Bryan Lohse, Haley A Bento and 3 others
PMID 30172645WHAT IT FOUND
The main stay after leaving ICU did not shorten significantly.
Adding CVICU physical therapists increased daily PT minutes and sessions. ICU stay was shorter in the staffing change period, but function and discharge level did not clearly change.
Key findings
01The primary post-CVICU length of stay was not significantly shorter: adjusted change was a decrease of 2.2 days (95% CI: -6.0, 1.6).
02During the staffing change, PT treatment increased: mean daily duration rose from 51.7 to 59.4 minutes (adjusted difference 9.6 minutes, 95% CI: 1.9, 17.2), and frequency rose from 0.59 to 0.76 treatments per ICU day (adjusted difference 0.16, 95% CI: 0.06, 0.27); no adverse events were recorded in association with PT treatment.
03CVICU length of stay was shorter during the staffing change (adjusted decrease 3.6 days, 95% CI: -6.4, -0.8), but physical function and discharge level did not differ significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a single-center retrospective before-and-after study, so other changes in the ICU during the periods could have affected outcomes. There was no random allocation, and no standard PT protocol was established; therapists used clinical judgment. The baseline group had a higher mean comorbidity burden, although comorbidity was not significant in the main post-CVICU length-of-stay model. Occupational therapy and nurse-led mobility interventions were not measured, so their possible contribution is unclear. Women were underrepresented in the sample. Many QI patients were discharged directly from CVICU (43.5% versus 28.8% in baseline), which could influence post-CVICU length of stay. The AM-PAC-Mobility may not capture small meaningful function changes in critically ill patients. The survivors-only results are a secondary analysis and should not be treated as the main finding.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that adding CVICU physical therapists will shorten stays or improve function. The main stay after leaving ICU did not shorten significantly, and function and discharge level did not differ significantly. This was a single-center before-after study, so other changes could have contributed.