1. Rocket science or Rehabilitation Stuart Fraser Therapy manager - Neurosciences University Hospital Southampton NHS Foundation Trust

3. Rehabilitation
‘ To restore someone to health through training and therapy after illness’

4. What are the challenges
Health care costs
Ageing population
Growing population
Private sector
Lifestyle
Public expectations
Rising Acuity
Communication
No: of organisations

5. AGE!

6. AGE INJURY
Falls less than 2 metres in SCAS catchment area - huge

7. INJURY DEMOGRAPHICS

8. LIVING LONGER
Pre Major trauma

9. What are the challenges
Healthcare costs Ageing population Growing population Private sector
Lifestyle Public expectations Rising Acuity Communication! No: of organisations!

10. Early Mobilisation Project

11. Why EMP?
Survival following critical illness is often associated with a poor functional outcome
Herridge et al 2011 NEJM: 364;
The combined effects of reduced sedation and physical activity are safe, well tolerated
Schweickert et al 2009 Lancet: 373:
Early mobilisation is defined as occuring within the first 2-5 days of admission, but barriers to this are often reported
Hodgson et al 2013 Crit Care: 17:207
CG 83 in 2009
Recommendation to start rehab as early as possible

12. What did we ask for?
Small investment
Staff
Equipment

13. How did we do it? Inclusion Acute medical patients <72 hours I&V
Expected to remain I&V >24hours
Functionally independent prior to admission (+/- aid)
Intervention
Strict sedation protocol- minimal sedation at all times
2x 30 minute additional therapy sessions per day

14. Clinical outcome data for ICU survivors enrolled in the QI project (Pre-QI data is included for comparison)
Data are expressed as mean (standard deviation), unless otherwise indicated.
Pre-QI
Improvement Cycle 1
Improvement Cycle 2
January to March
2012
(n = 16)
2013
(n = 19)
2014
(n = 24)
2015
(n = 22)
2016
Time to first out of bed mobilisation (days)
16.3 (10.9)
9.3 (8.3)
6.4 (4.1)
8.0 (4.7)
4.3 (2.7)
ICU length of stay
20.8 (15.5)
18.9 (19.5)
13.0 (9.6)
14.2 (8.5)
11.2 (7.7)
Hospital length of stay
45.4 (50.4)
36.9 (28.3)
30.2 (23.7)
33.5 (32.2)
29.6 (18.4)
Duration of mechanical ventilation (days)
15.8 (14.6)
13.8 (16.0)
7.3 (6.9)
7.9 (6.2)
8.7 (6.1)
Ventilator-free days (within first 28 days)
14.4 (9.9)
17.1 (9.3)
20.7 (6.9)
20.2 (6.2)
19.3 (6.1)

15. What did we do next?

16. Neurological Intensive Care

17. Achievements

18. In summary Its not rocket science! Investment / savings Safe
Promotes therapists as being leaders in Rehabilitation
It’s the right thing to do

19. Thank you