Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit

Objectives: To determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes. Design/Methods: Prospective, longitudinal, comparative study using three time points (pre-, immediate post-intervention and 12-month post-intervention sustainability). Analyses included comparative statistics and multivariable modelling. Data were collected by clinical nurses, from administrative databases. Psychological health data were collected using a valid, reliable tool. Setting: Patients treated in a 22-bed Neurological Intensive Care Unit of a quaternary-care medical centre. Outcome measures: Highest mobility level, length of stay, mortality, discharge disposition, quality metrics and psychological profile including depression, anxiety, and hostility. Results: Amongst 260 pre-intervention, 377 post-implementation, and 480 twelve-month post-implementation patients (N = 1117) walking increased post-implementation and was sustained at the eight-month assessment, p <.001. After multivariable adjustment, unit and hospital length of stay and psychological distress were reduced compared to the pre-early mobility programmes (all p <.001). There were no differences in discharge disposition (i.e., home vs skilled nursing facility), mortality or quality metrics. Conclusion: Ongoing implementation of an early mobility programme in a neurological intensive care environment led to sustained improvement in patients' level of mobility, length of unit and hospital stay, depression, anxiety and hostility levels. (C) 2018 Elsevier Ltd. All rights reserved.