The intensive care unit (ICU) in a hospital is often a necessary stop for the most critically ill and injured patients who need continuous monitoring and treatment. But those prolonged stays can take a toll on a patient’s body.
Days or weeks on bed rest in the ICU can cause muscle weakness that can last for much longer than the hospital stay itself. To limit those debilitating side effects, nurses staffing the ICU at the University of Minnesota Medical Center’s East Bank Hospital started a rehabilitation program that gets ICU patients up and walking—even those who need medical support from life-saving machines.
The goals of the new ICU early mobility program at University of Minnesota Medical Center are simple: Reduce use of sedatives or painkillers in the hospital setting, promote faster healing through physical conditioning and improve the patient’s quality of life.
The idea sprouted with Nurse Manager Chris Linke, RN, BSN, and other members of the surgical, medical and cardiovascular critical care units at University of Minnesota Medical Center.
“Our team attended a critical care conference in 2015, where we learned about the successes other health systems were having with early mobility," Linke said. "After the conference, we couldn’t wait to get back to work and apply what we learned.”
To turn the idea into a reality, Linke and others established an interdisciplinary team of hospital specialists who interact with ICU patient. This included physicians, nurses, physical and occupational therapists and other specialists.
Linke and the team began with the most complex cases. “Our methodology was, if we could be successful with the most advanced and critically ill patient, we could make this work for everyone,” Linke said.
For Linke and other ICU specialists, that meant the elderly.
“The challenges in the ICU affect patients of any age,” Linke said. “But because the elderly are definitely more vulnerable because of their already-decreased muscle mass, we knew that was a target audience we wanted to focus on.”
“We first started by seeing how much the patient could tolerate any range of motion,” Linke said. “And then we would get the patient to a sitting position on the edge of their bed, then to standing, and eventually walking.”
Many patients are easily winded after long periods of inactivity, so Linke and the team employ breathing exercises in addition to progressive physical conditioning. The team also builds rest and recovery time into each mobility session in order to avoid over-exertion.
One by one, they started getting ICU patients out of bed. And the results were astounding.
“One big improvement that we’ve realized is the decreased time on a ventilator,” Linke said. “This contributes to a quicker recovery, less time in the ICU and a huge cost savings.” Patients have also experienced a reduction in other common ICU side effects, like muscle loss, restlessness, anxiety and delirium, Linke added.
And when patients or family members see other ICU patients walk down the hall, it gives them hope.
That was certainly true for Ben, who was one of the first ICU patients to try the program in 2017. “Being able to walk was very empowering, and I felt like I was contributing to my healing and recovery,” he said.
“Patients are the single biggest driver of this program. I want to improve the quality of their life after they leave the ICU,” Linke said. “All of my hours of research, endless meetings and hard work paid off when I got my first patient to her feet. I’ll never forget the smile on her face.”