The Intensive Care Unit (ICU) in a hospital is a necessary stop for the most critically ill or injured patients who need continuous monitoring and treatment. But those prolonged stays can take a toll on a patient’s body.
If doctors’ orders include days or weeks on bed rest in the ICU, it can cause muscle weakness that can last for years after discharge.
To help limit those debilitating side effects, one of our ICUs started getting patients up and walking – even patients who are dependent on life-saving machines.
The idea started with Nurse Manager Chris Linke and other members of the medical, surgical, and cardiovascular ICU teams 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," Chris recalls. "After the conference, we couldn’t wait to get back to work and apply what we learned.”
An interdisciplinary team was established that included anyone who interacts with ICU patients: physicians, nurses, and physical and occupational therapists, among others.
To create a "gold standard," Chris and team started 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.”
“The challenges in the ICU affect patients of any age,” Chris says. “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,” Chris recalls. “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 because of being inactive for so long, so Linke and the team employ breathing exercises in addition to progressive physical conditioning.
One by one, they started getting patients out of bed. And the results were astounding.
“One big improvement that we’ve realized is the decreased time on a ventilator,” Chris says. “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.
“Anecdotal evidence is everywhere that this is working,” Chris says.
And when patients or family members see other ICU patients walk down the hall, it gives them hope.
That was certainly true for Ben, a patient in 2017 who was one of the first to try the program. “Being able to walk was very empowering," he recalls, "and I felt like I was contributing to my healing and recovery.”
Plans are now under way to integrate the early mobility program into ICUs throughout the Fairview system.
“Patients are the single biggest driver of this program. I want to improve the quality of their life after they leave the ICU,” Chris says. “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.”