A mobility protocol that gets intensive care unit (ICU) patients out of bed and walking as early as possible, even while they are hooked up to a portable ventilator, can save the hospital some serious money, according to a study presented here at the Society of Critical Care Medicine 40th Critical Care Congress.

Incorporation of a mobility protocol into the ventilator bundle resulted in a total annualized savings of $2,887,008 for St. Cloud Hospital, a community hospital in St. Cloud, Minnesota. The substantial cost savings also came with a reduction in length of hospital stay and a decrease in hospital mortality, said John Olsen, MD, codirector of the hospital’s ICU.

“I had a desire to get patients who are on ventilator support up and walking in the hallway. The data we saw from other studies showed that it was safe and beneficial, but there was little data to show what the financial outcomes were of enhancing mobility for these patients,” Dr. Olsen explained to Medscape Medical News in an interview at his poster.

The protocol involved assessment by a physical therapist of all ventilated patients after 24 hours of ventilatory support and aggressive and progressive physical therapy. Patients who were on ventilator support less than 24 hours, as well as all cardiac surgical patients, were not included in the mobility protocol.

“All patients got a certain amount of therapy — range of motion, turning in the bed, sitting on the bed, things like that. If they were unstable, they didn’t progress from that point, but when they became more stable, although they were still on the ventilator, they would go from basic simple activity to more progressive activity. They went from standing by the side of the bed to walking down the hallway, which was the ultimate goal,” Dr. Olsen said.

Data on hospital and ICU direct costs, length of stay, ventilator hours, and hospital mortality were collected for the last 6 months of fiscal year 2009, which represents the benchmark period before the mobility protocol was started, and again for the last 9 months of fiscal year 2010, which was the study period.

There were 145 patients in the benchmark period and 366 patients in the study period. Physical therapy assessment was performed on 17.9% of the benchmark patients and 44.6% of the study patients.

In the benchmark period, the mean hospital costs were $56,187. After implementation of the mobility protocol, these dropped to $50,271.

The mean ICU cost fell from $38,062 to $33,560. Hospital length of stay fell from 16.1 to 14.5 days, and length of stay in the ICU fell from 8.7 to 7.0 days. Ventilation hours fell by 0.8%.

Hospital mortality fell from 32.4% to 23.8%. “I certainly can’t explain that change, but it was what we observed,” Dr. Olsen said. “It could be a random event, but a recent study suggested that using a mobility [protocol] reduced sedation requirements, and this could translate into improved mortality. We also saw a shorter length of stay in the ICU; being there isn’t necessarily healthy, so getting out early could potentially be a benefit from the mortality standpoint.”

A mobility protocol should be a component of ventilator support, he stated.

“Just as giving [deep vein thrombosis] prophylaxis, sedation vacations, and raising the patient’s head are all part of being on a ventilator, I think that mobility should also be part of being on a ventilator. It’s easily accomplished, it’s safe, it doesn’t take a lot of resources — just willing nurses and a physiotherapist, really — and it could potentially save a lot of money for your hospital. In 9 months, we saved over $2 million.”

“This is nicely done,” said Christopher Farmer, MD, from the Mayo Clinic in Rochester Minnesota, and comoderator of the poster session. “This is the kind of work that hospital administrators need to be aware of so that they can see that there is a measurable benefit from instituting these kinds of things.”

Comoderator Philip Barie, MD, from Weill Cornell Medical College in New York City, agreed that the study was interesting and important, but added a caveat.

“You always have to be circumspect about studies that purport to curtail costs, because cost is a very difficult thing to quantify in a hospital setting,” he cautioned.

Dr. Olsen, Dr. Farmer, and Dr. Barie have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 40th Critical Care Congress: Abstract 95. Presented January 16, 2011.

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