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1392: IMPLEMENTATION OF EARLY MOBILITY GUIDELINES IN A PICU EVALUATION OF ADHERENCE AND OUTCOMES

Learning Objectives: Critical illness increases the risk of cognitive, physical and emotional morbidities in surviving children. Intensive care unit-based mobility programs improve multi-domain outcomes in adults. The objective of this quality improvement study was to assess adherence to implementation of locally developed pediatric intensive care unit (PICU)-based mobility guidelines complimented by an electronic order set and unit-wide education and to evaluate impact on patient outcomes. Methods: This pre (Oct-Nov 2017)-post (April-May-2018) guideline implementation study evaluated patients admitted to a tertiary PICU for > 72 hours. Primary outcome was guideline adherence. Secondary outcomes focused on resource utilization and patient outcomes including change in Functional Status Score (FSS) at discharge from pre-morbid status. Results: Overall, 89 patients were included in the study (pre-implementation (pre-I) n=34, post-implementation (post-I) n=55). Patient sex, baseline FSS, and severity of illness based on a novel clinical classification scale were similar between groups. Patients in the pre-I phase versus post-I were younger (median years: 9 (IQR 1, 18) v. 3 (IQR 0, 8). Compared to pre-I, post-I patients were evaluated more by physical (PT) and occupational therapy (OT) by 72 hours of ICU admission (18% v. 82%, p<0.01). Pre-I 44% of patients received no PT or OT therapy sessions during admission compared to only 20% post-I (p<0.01). The frequency of PT and OT deferrals were similar (PT: 41% v. 23%, p=0.13, OT: 33% v. 28%, p=0.48) and most commonly due to nursing and family concerns about patient agitation and sedation. Compared to the pre-I, there was an increase in PT and OT outpatient referrals in the post-I group (39% v. 63%, p=0.03). The number of patients with an increase in FSS at time of hospital discharge did not differ following implementation (35% v. 29%, p=0.54). Conclusions: Implementation of PICU-based mobility guidelines successfully increased consultation and patient exposure to PT and OT and may have led to increased recognition of functional deficits requiring continued therapy. There was no significant difference in functional status at discharge, however, PT and OT deferral rates indicate a need for increased parent and staff education to improve treatment adherence.