presented by Ellen Hillegass
Therapists are often challenged when presented with complex ICU patients. These patients may have cardiovascular and/or pulmonary complications or dysfunction, as well as other medical conditions. They may also have many lines or tubes. This course provides therapists with the evidence of the difficulties associated with early mobilization of these patients, as well as the evidence in favor of early mobility. The evidence-based outcomes and benefits of early mobility will be discussed, along with the barriers to achieving early mobility. An overview of the process for initiating an early mobility program will be presented and helpful resources suggested. The types of patients most effected and the knowledge and skills that the PTs will most need will be presented, along with various interventions that may be utilized.
Dr. Ellen Hillegass is a physical therapist with APTA board certification in cardiovascular and pulmonary clinical specialty. She currently holds the position of adjunct professor in the departments of physical therapy at Mercer University in Atlanta and Western Carolina University in Cullowhee, NC. Ellen is also the president and CEO of Cardiopulmonary Specialists, a private consulting firm that provides consulting and education on cardiac and pulmonary rehabilitation. Additionally, she is a partner in PT Cardiopulmonary Educators, a web-based education company for entry-level DPT, residency, CCS board preparation, and continuing education. She also presents courses across the country on early mobility. She has been active in the cardiovascular and pulmonary section for many years and is the former Payment and Policy chair for the cardiovascular and pulmonary section. She has represented the cardiovascular and pulmonary issues of physical therapists at the Centers for Medicaid and Medicare Services along with the APTA on several occasions. Dr. Hillegass started a clinical residency through Mercer University in conjunction with Piedmont Hospital and works with the residents in the ICUs on a weekly basis. Her first resident was recently awarded their CCS this past February at the APTA CSM meeting in San Antonio, where two former residents presented their research as well (one on walking IABP and one with a poster on early mobility). Ellen Hillegass is a member of the Board of Directors of the US COPD Coalition, as well as the chair of the COPD Coalition Strategic Planning Committee. She was the chair of the Clinical Practice Guidelines Committee on Venous Thromboembolism for the APTA (published in Physical Therapy journal in Febrary of 2016), and is the past chair of the Oxygen Recommendations Task Force for the APTA. She is a Catherine Worthingham fellow of the American Physical Therapy Association. She is the editor of Essentials in Cardiopulmonary Physical Therapy, an entry-level text with its fourth edition published in June 2016, as well as the author of a clinical notes book entitled PT Clinical Notes (formerly Rehab Notes). Ellen received her entry-level training in physical therapy from the University of Pennsylvania, her Master of Medical Science in Cardiopulmonary Physiology from Emory University, and her doctorate in Exercise Physiology from the University of Georgia. Her dissertation involved muscle morphology in the spinal-cord injured patient.
Patients have been kept on bedrest and sedated when seriously ill or on mechanical ventilation for fear of instability, for “rest,” or for fear of tube or IV removal by the patient. As a result, these patients have developed profound muscle weakness, problems with orthostatic hypotension, and aerobic deconditioning. With earlier mobility, patients have demonstrated less weakness, less deconditioning, and fewer long term impairments.
As a result of initiating early mobility, studies have shown decreased length of stay, decreased ICU length of stay, decreased ventilator days, less time until first time out of bed, and less costs. Initiating an early mobility program would cut costs for the hospital as well as improve function.
Multiple barriers exist to initiating and maintaining an early mobility program, including sedation, staffing, time requirements, ICU culture, etc. These barriers are discussed as well as recommendations to address, decrease, or remove the barriers.
Initiating an early mobility program is made easier by learning from others who have implemented a program and can share pitfalls and successes. Developing a team and identifying a champion are some of the keys to success. In addition, ongoing communication and education are also very important to include.
Specific patient populations are discussed, including some of the special considerations that need to be taken with these patients, as well as a discussion of what needs to be considered and how to move these patients. Some of the patient populations that are discussed include the mechanically ventilated patients, patients on ECMO, and patients who have advanced heart failure, including pre- and post VAD, on those IV inotropes, and those with multisystem failure. Included in this section are assists to mobility.
Measuring the appropriate outcomes is important to demonstrate success of your early mobility program and communicate the functional improvements of the patients as well as the cost savings to the institution. Besides outcomes that can be gathered from the EMR, the physical function measures that should be recorded are discussed.