Development and Implementation of an Early Mobility Guideline for Traumatic Brain Injury Patients in a Shock Trauma Intensive Care Unit

Background: Traumatic brain injury (TBI) patients often remain bedbound for prolonged periods in intensive care units (ICU) due to a lack of resources and collaboration between interdisciplinary teams, in addition to poorly specified guidelines for patient mobilization. Early mobility programs have been shown to improve function, increase strength, decrease delirium, and reduce ICU and hospital length of stay. Length of stay hospital days were decreased by 45% after starting an early mobility program. Methods: A quality improvement project was developed to promote improved clinical outcomes and early mobilization for post-traumatic brain injury patients within a community hospital ICU in Utah. First, multidisciplinary team members were assessed with a pre-intervention survey to identify knowledge, attitudes, and feasibility regarding early mobilization programs. A best- practice guideline was developed and disseminated to the multidisciplinary team via in-person presentations to go over safety concerns and exclusion criteria, as well as proper use of the guideline. Post-implementation surveys were sent to the multidisciplinary team to determine the success and effectiveness of the early mobility guideline. Results: Comparison of pre- and post-surveys results may demonstrate a significant difference in opinion regarding early mobility for TBI patients, including an improvement of early mobility guidelines understanding (p=0.0003) and increased confidence in the ability to perform out of bed mobility, range of motion, and early mobilization (p=0.038). Conclusions: The early mobility guideline promoted engagement of the multidisciplinary team and may have helped to improve clinical process measures for TBI patients. It provided a definitive guideline on how to safely proceed with early activity TBI patients and likely fostered empowerment within the multidisciplinary team. Continuation of this quality improvement project is needed to demonstrate strong improved patient outcomes and eradicate barriers to early mobility.