(1117) Challenges in Implementing a Pediatric Critical Care Early Mobility Program

Introduction: The Society of Critical Care Medicine recommends implementing an early mobility program as part of the pediatric PADIS guidelines. This project’s aim is to implement a mobility pathway through the standardization of physical and occupational therapy referrals for pediatric patients admitted over 72 hours within pediatric critical care at Yale New Haven Hospital.

Methods: A key driver diagram was developed to identify potential intervention targets, including mobility education, staff awareness, pathway development, and equipment needs and availability. Physical and occupational therapy referrals within the PICU and PCICU were monitored via an existing rehabilitation dashboard. An interdisciplinary approach was utilized, representing medical, nursing, and rehabilitation staff. PICU and PCICU employees completed a survey evaluating current impressions of mobility and barriers to implementation

Results: Twenty-two out of 36 unit staff surveyed (response rate 60%) responded, reflective of an interdisciplinary team encompassing nurses (10), medical providers (n=10), and rehabilitation services/ancillary staff (n=2). Staff endorsed concerns for equipment and staffing availability, knowledge deficit regarding assistive devices and safe movement, and provider consistency. Initially anticipated barriers included staff knowledge deficit, pathway approval, and equipment availability. Unexpected implementation needs included PICU admission order set revision, the creation of a daily rounding template, unit onboarding process changes, and assistive device training. While consultations for rehabilitation services more than doubled between January 2022 and April 2023 (n= 10, n=25), this data is limited in interpretation because it is not compared to overall eligibility numbers during this time frame.

Conclusions: During the initial implementation of a pediatric critical care early mobility program, we encountered multiple anticipated and unanticipated challenges that were accommodated by a multidisciplinary approach.