Using EMR communication tools to improve mobility of ICU patients
Electronic medical records innovations to promote early patient mobility in an intensive care unit
DNP focus area: Adult-Gerontology Acute Care Nurse Practitioner
Early ICU mobility programs (EMP-ICU) improve patients’ physiological and psychological outcomes while providing system cost benefits. Inadequate interprofessional communication is a known barrier to achieving successful EMP-ICU outcomes. Electronic health record communication tools (EHR-CT) promoting interprofessional communication have demonstrated improved patient outcomes; such application has not been evaluated regarding ICU mobility.
The purpose of this quality improvement project was to implement an early mobility collaboration program in an existing EMP-ICU, consisting of EMP-ICU protocol education and an EHR-CT to improve interprofessional communication and collaboration, patient outcomes, and decrease healthcare cost.
Medical ICU patients on mechanical ventilation (MV) were the target population. Phase 1: Staff viewed an online educational module reviewing EMP-ICU literature, the institution’s existing mobility protocol, and the Mobility Level grading scale. Phase 2: EHR-CT displayed recently charted Mobility Levels to all care providers. Staff EMP-ICU knowledge and perceptions of mobility-related communication were assessed by survey; patient outcomes including mobility goals, MV time, ICU stay, and cost were assessed by chart review.
There was a significant increase in staff satisfaction with mobility-related communication (p=0.0003) and communication frequency (p=0.015), but not staff knowledge (p=0.280). Hours to mobility goal (p=0.015) and length of ICU stay (p=0.023) decreased significantly. Average ventilator time decreased 27 hours. Discharge recommendations at higher functional levels increased. A system benefit of decreased total ICU cost (-39.5%; p=0.041) was noted.
Interprofessional communication and collaboration leads to improved outcomes. Combining routine educational reviews and EHR-CT may improve patient and system outcomes for EMP-ICU patients.