ICUs bring on full-time PTs/OTs to get patients stronger, faster
By Matt Westerfield
Nurses and therapists cheered on Meeka Reed of Jackson as she walked down the hallway of the Surgical ICU last week.
She had been in bed for almost two weeks following surgery for an infection in her jaw. She was weak, but she walked with the aid of occupational and physical therapists and a patient-lifting device. Not only that, she did it while on a ventilator.
As patients in intensive care units often are sedated and on bed rest for long periods of time, the more movement and mobility health-care providers can help them achieve, the better. But ambulating a ventilated patient in the SICU is a milestone, according to nurse manager Kim Dukes Horn.
"As nurses, we know mobility is very important, but it's not at the forefront of what we do because we're focused on so many other things," Horn said.
Which is why, for the first time at UMMC, the Division of Rehabilitation Services
has committed an OT and a PT five days a week to both the SICU and Medical ICU with the goal of promoting early mobilization and getting patients better faster.
"This is the missing piece of the puzzle," Horn said. "She (Reed) is going to be so ahead of the game because of this."
What's more, the concept represents a seamless collaboration between physicians, nurses and therapists.
"The multidisciplinary team discusses the patients each day and uses a protocol to identify the patient's functional mobility level and ability to participate in therapy," said Amy Mayhue, assistant director of occupational therapy
and interim assistant director of physical therapy
. "Previous to this, therapy saw only select patients identified by the physician, with limited focus on early mobilization in the ICUs."
Which is to say, Reed would not be getting the same daily level of therapy before this new approach.
"We were trying to see if we could get her off the ventilator, but we couldn't for a couple of reasons," Dr. Liz Robertson said of Reed, who was given a tracheostomy
to help her breathe. "But she's awake, and she's been doing exercises since the day she got here to keep her strength up."
Robertson, a critical care fellow, credits Dr. John Porter
, chief of trauma/critical care surgery, for initiating the request to have PTs and OTs assigned to the ICU rather than assigned to an individual patient.
"At the same time, Amy Mayhue got a hold of me as the SICU fellow, and we were talking about how to improve things and what we could do," Robertson said. "We sat down and I said, 'I think we all want the same things, but our great barrier is communication.'"
What they came up with was a commitment of one PT and one OT from rehab services staff for both the MICU and SICU for roughly three-month rotations. Robertson said that since the therapists became part of the unit last month, the staff nurses quickly built strong working relationships with them.
Both Robertson and Mayhue say this approach leads to quicker recovery times for the patients and shorter stays in the ICUs.
“Instead of leaving people in bed, we’re getting them stronger, faster,” Robertson said. “If you took an 18-year-old soldier, put him in bed and didn’t let him do some walking, you’d need physical therapy after about 3-5 days to get him walking again. And these people are clearly sicker than a healthy soldier.
“The sooner you can get them moving and exercising, the better they’re going to do because once you strengthen their limbs, you strengthen their lungs and their heart.”
Previously, there might have been a 12-hour turnaround for getting a therapy consult in the SICU, she said. Now, therapy is much more a part of the critical care process.
“Even when they’re on a ventilator and they’re intubated, we can start earlier strengthening,” said physical therapist Morgan White, who was part of the team helping to get Reed up and moving. “And now we’re trying to progress to earlier mobilization because you have to be strong enough to sit up, strong enough to stand.”
And that’s where the PT and OT complement each other, White said. To put it very simply, the PT works on the legs and the OT works on the arms.
“In situations like these, you can’t perform activities of daily living if you can’t get out of bed,” said occupational therapist Courtney Anders. “You can’t dress or feed yourself, you can’t go to the bathroom.”
Often, she says, patients they treat are so weak at first they can’t even reach a hand to their mouth.
“So one of our goals is just to get them to be able to touch their nose or chin to be able to get them to some form of independence.”
The achievement of getting Reed up and walking in her weakened state while on a ventilator was evidence that the approach is already yielding benefits, Mayhue said.
“The success of this patient speaks to the communication and relationship the entire team has built in just one month,” she said.