Automated Physical Therapy Consultation in ICU Patients: A Quality Improvement Project

BACKGROUND: This project examined the impact of early physical therapy (PT) initiation on reducing intubation duration in mechanically ventilated patients. Evidence suggests that early physical rehabilitation can decrease time spent intubated, improve patient outcomes, and decrease healthcare costs, yet delays in PT consultation remain common in the intubated patient population.

LOCAL PROBLEM: This project aimed to address delays in PT consultation following the arrival of mechanically ventilated patients to the cardiovascular intensive care unit (CVICU) or after intubation in the CVICU. The aim was to increase PT consults that are ordered within four hours of the patient’s arrival to the CVICU or within 4 hours of intubation in the CVICU by 20%.

METHODS: This project utilized the Evidence-Based Practice Improvement Model and Plan, Do, Study, Act cycles as a framework for improvement. The impact of the criteria-based PT consult order on consultation rates and therapy initiation was evaluated.

INTERVENTIONS: An existing facility mobility protocol was adapted for use in the CVICU, providing nursing and PT staff with a standardized framework for early mobility. The team collaborated with the Information Technology department to integrate a PT consult order into the existing CVICU post-intubation order set pathway. The consult was intended to be automatically triggered but transitioned to become a criteria-based order per PT leadership’s request.

RESULTS: Of 24 intubated patients, 16 (67%) received PT consults. The average time from when a patient met criteria to when a PT consult was ordered was 4.5 days. The average time from when a patient met criteria to when the PT consult was completed was 6 days. Only 12.5% of PT consults were completed within 24 hours of ordering.

CONCLUSIONS: Implementing a criteria-based PT order did not improve consultation times, likely due to reluctance to use the arduous criteria for order instigation. This inefficient process perpetuated significant delays in care.