A patient in her eighties had come to Sunnybrook Health Sciences Centre in Toronto for an elective procedure, but after a seizure she was put on a ventilator in the critical care unit.
Things didn’t look good. Even so, on Day 3, her care team started to wean her off sedation and helped her sit up in bed. Three days later, she was walking around the unit.
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“When you see a ventilated patient up and walking, you can’t help but get excited.”
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“When you see a ventilated patient up and walking, you can't help but get excited,” says Karen Montgomery, a critical care therapist at Sunnybrook.
Montgomery learned how to get the patient moving by participating in an
IHI “live case study” visit at Intermountain Healthcare in Salt Lake City, Utah. The program grew out of pioneering work by IHI faculty Terry Clemmer and Vicki Spuhler of Intermountain, and Wes Ely of Vanderbilt University School of Medicine.
During the visit, Intermountain ICU staff performed delirium assessments, used protocols for early removal of sedation, and mobilized ventilated patients. “I was shocked,” remarks Genny Ng, a Sunnybrook respiratory therapist who attended the program. “We saw a lot of ventilated patients, and instead of getting bed baths they were walking to the shower.”
There is growing evidence that mobility
can help a patient's long-term recovery.
Patients in critical care are usually kept immobile and heavily sedated, but there’s growing evidence that these practices can seriously damage patients’ long-term recovery.
After their Intermountain visit, the Sunnybrook team began identifying patients who were good candidates for early mobility — as well as nurse and physician champions.
“We needed to take baby steps initially,” says Linda Nusdorfer, an advanced practice nurse. “One nurse kept refusing to help mobilize her patient,” Montgomery recalls. “We got someone else to help, and eventually the nurse came around when she saw how the patient benefited.”
Although it’s too early to see the effect of the protocol on outcomes, it’s clear that Sunnybrook’s culture is changing. “We expect our patients to get up and walk or sit,” observes Montgomery. “The nurse says, ‘Okay, what are we doing to get this patient moving?’”
