From Little Things Big Things Grow Allied Health Symposium 2014 Presented by Margot Green Cardiorespiratory Clinical Educator Physiotherapy Department

Acknowledgements Core research team ANU Medical School Private Practice Fund (PPF) Allied Health Adviser’s Office ICU Physiotherapy Department Consent obtained for video used in this presentation

Early Mobilisation Canberra Hospital ICU has practiced a strategy of de-sedation & early mobilisation for > 10 years In 2008 evidence started emerging around early mobilisation in invasively ventilated ICU patients

We Had a Problem NO DATA AVAILABLE ON OUR MOBILISATION PRACTICES

What did we do? ‘Informal’ QI project : Barriers to mobilisation – Unavoidable factors – Potentially avoidable factors Mobilisation episodes – number and types of mobilisation Adverse events

What I learned along the way The power of data to change practice Low risk ethics applications are required for publication You can publish a 1 month prospective audit 3 years after the study Data cleaning takes time……..

The Vision – the long road Canberra Hospital ICU to be a centre of excellence for early mobilisation & rehabilitation The dream: ACT Health to have a MDT ICU follow-up clinic ICERT Intensive Care Early Rehabilitation & Training

Collaborative Research Projects Mobility Status at ICU discharge predicts hospital discharge destination in long-term Intensive Care Unit (ICU) patients. Presented at European Society of Intensive Care Medicine (ESICM) Annual Scientific Meeting Lisbon Presented at Australian and New Zealand Intensive Care Society ASM, Brisbane 2011 Green M, Leditschke IA, Williams N, Murray M, Walker M, Mitchell IA, Bissett B Acute Care Index of Function predicts hospital discharge destination in intensive care patients expected to be ventilated for greater than 72 hours – a prospective observational study. Critical Care (Under Review) Presented at ESICM Annual Scientific Meeting Paris Latham S, Green M, Mitchell I, Bissett B, Neeman T, Leditschke I.

Collaborative Research Projects Mobility status versus Acute Care Index of Function to predict hospital discharge destination in intensive care patients Presented at 1 st European Conference on Weaning and Rehabilitation in Critically Ill Patients. Vienna 2013 I Anne Leditschke, E Cole, S Latham, M Green, I Mitchell, B Bissett, T Neeman The Goal-directed Sedation and Mobilisation (GoSaM) Study – Planning commenced in 2012 – Recruitment commenced in 2013 M Green, I Anne Leditschke, S Chan, B Bissett, I Mitchell, V Marzarno, T Neeman

Challenges/Barriers Clinician lead research Winning funding Stress management – Meeting deadlines – Multiple unsuccessful grant applications Maintaining motivation with expanding study timeframes The last hurdle  publication

Recommendations Mentor/s Realistic learning outcomes, plans & timeframes Research Team – Work to team members strengths & workloads – Medical Champions Thick skin

Building Research Capacity Hard work & takes time Stability within teams Plan, prioritise & set goals – QI/research/service delivery Culture that strives to improve patient outcomes whilst providing a high quality service Funding options & university affiliations