The Economic and Clinical Impact of Sustained Use of a Progressive Mobility Program in a Neuro-ICU.

ABSTRACT

OBJECTIVE: To investigate a progressive mobility program in a neurocritical care population with the hypothesis that the benefits and outcomes of the program (e.g., decreased length of stay) would have a significant positive economic impact. DESIGN: Retrospective analysis of economic and clinical outcome data before, immediately following, and 2 years after implementation of the Progressive Upright Mobility Protocol Plus program (UF Health Shands Hospital, Gainesville, FL) involving a series of planned movements in a sequential manner with an additional six levels of rehabilitation in the neuro-ICU at UF Health Shands Hospital. SETTING: Thirty-bed neuro-ICU in an academic medical center. PATIENTS Adult neurologic and neurosurgical patients 1,118 patients in the pre period, 731 patients in the post period, and 796 patients in the sustained period. INTERVENTIONS: Implementation of Progressive Upright Mobility Protocol Plus. MEASUREMENTS AND MAIN RESULTS: ICU length of stay decreased from 6.5 to 5.8 days in the immediate post period and 5.9 days in the sustained period (F(2,2641) = 3.1; p = 0.045). Hospital length of stay was reduced from 11.3 ± 14.1 days to 8.6 ± 8.8 post days and 8.8 ± 9.3 days sustained (F(2,2641) = 13.0; p < 0.001). The impact of the study intervention on ICU length of stay (p = 0.031) and hospital length of stay (p < 0.001) remained after adjustment for age, sex, diagnoses, sedation, and ventilation. Hospital-acquired infections were reduced by 50%. Average total cost per patient after adjusting for inflation was significantly reduced by 16% (post period) and 11% (sustained period) when compared with preintervention (F(2,2641) = 3.1; p = 0.045). Overall, these differences translated to an approximately $12.0 million reduction in direct costs from February 2011 through the end of 2013. CONCLUSIONS: An ongoing progressive mobility program in the neurocritical care population has clinical and financial benefits associated with its implementation and should be considered.