Short summary

Early mobilization has a positive effect on patients' rehabilitation. In this project, we develop a tool to support interdisciplinary cooperation and patient involvement, in order to optimize early mobilization in the intensive care unit (ICU).

Rationale

In Denmark, 30.000 patients are treated in an ICU every year. An ICU admission can cause a variety of physical and psychological health challenges years after discharge. Early mobilization can improve muscle strength, physical function, walking ability and days alive and out of the hospital. Early mobilization is an achievable and safe procedure for patients, who are intubated and mechanical ventilated.

Despite positive effects, only 8-16% of the patients are mobilized early in the ICU, which indicates that current healthcare practice can be improved.

A change in medical treatment, towards less sedation of mechanically ventilated patients, is implemented in the ICU within the last decade. This makes it possible for patients to interact and participate in various activities according to their actual resources.

To summarize, there is a need to support early mobilization in the ICU to improve the patient's rehabilitation. This can be done by facilitating cooperation and patient involvement in finding new tools and new ways of delivering and organizing healthcare.

The overall purpose of the project is to optimize early and active mobilization in the ICU, by developing a supportive tool involving patients and relatives and facilitating interdisciplinary cooperation.

The project consists of 3 research phases with the following objectives:

To identify interactions and needs associated with early mobilization of involved patients, relatives and healthcare professionals; physicians, nurses and physiotherapists 

To design and develop a supportive tool for early active mobilization

To test and evaluate the solution

The project is based on a participatory design where an important cornerstone is user involvement and finding solutions to encounter the actual problems and needs of the users. The research process is explorative. 

Participatory design has succeeded including highly vulnerable patients with limited resources. In this study, we will be aware of to the vulnerable condition of the patients and relatives. The authorized healthcare professionals involved in the project will show sensitivity and empathy. The study will be carried out over a period of 4 years, to secure inclusion and data collection due to the patient's vulnerable condition. The project will be performed according to current scientific ethical guidelines. 

The project will contribute to a new understanding and development of our practice, where timing and organization of early and active mobilization supports the patients' needs, both physically and psychosocially. It will also highlight new knowledge about the involvement of patients and their relatives in a complex practice in the ICU with no-sedated mechanical ventilated patients.

The project will give a voice to patients and show how to organize rehabilitation in interdisciplinary cooperation involving the end-user contributing to better use of healthcare resources. 

An early and well-established rehabilitation starting at the ICU requires continuous effort, leading to the implementation of a coordinated rehabilitation across the health sector in order to support patients with a variety of diseases, physical and psychosocial challenges to resume their everyday lives.

Description of the cohort

The participants will be recruited among patients at ICU, their relatives  and Healthcare professionals, at the Intensive Care Unit at OUH, Svendborg Hospital and at the Intensive Care Unit (ITA2) at Odense University Hospital in Odense.

Inclusion criteria:

Patients over 18 years 

Endotracheal intubated within the last 24 hours and expected time on ventilator > 24 hours

Patients where mobilization is possible according to guideline and medical prescription

RASS: -1 / + 1, CAM-ICU negative 

Relatives present at the bedside together with the included patient and over 18 years  

Physicians, nurses and physiotherapist working at the included ICUs

Exclusion criteria:

Patients defined as no-touch on medical indication e.g. unstable condition or inevitably dying

Cognitive impairment (diagnosed with dementia, autism or mentally retarded)

Physical obstruction e.g. para-/tetraplegia and 

Unable to communicate in Danish or English  

Relatives with cognitive impairment (diagnosed with dementia, autism or mentally retarded) and

Unable to communicate in Danish or English 

Data and biological material

The project consists of 3 research phases where the following data is collected:

In phase 1, field-observations in the ICU are conducted and interviews with 10-12 patients and their relatives and with healthcare professionals. This is supplied with accelometery to monitor the patient's movement pattern.

In phase 2, a prototype of the tool is designed based on the findings in phase 1. The tool is tested and re-designed in a cooperative process involving representatives from all end-users and is organized in 3 workshops. The tool may end up as a communication tool, a shared decision-tool or a user-friendly digital platform supporting the coherence of the patient's life story from early mobilization to the functional level desired when everyday life is to be resumed. 

In phase 3, field-observations and interviews with 10-12 different patients and their relatives and with healthcare professionals are conducted, supplied with accelometery. Also a systematic evaluation of patient safety, clinical efficiency, patient-perspective, economic and organizational aspects are made.

Collaborating researchers and departments

Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital.

• Chief Physician, MD, PhD Hanne Tanghus Olsen &
•  Clinical Nurse Specialist Anja Egelund Hansen

Department of Anesthesiology and Intensive Care Medicine, OUH Odense Universitetshospital

•  RN, Phd Eva Lærkner & 
•  Clinical Nurse Specialist Kristian O'Reilly Poulsen

Department of Endocrinology, CIMT Center of Innovative Medical  Technology, Odense University Hospital / Department of Clinical Research; SDU

•  Main supervisor: Associate Professor, RN, PhD Mette Juel Rothmann

Department of Rehabilitation, Odense University Hospital

•  Co-supervisor: Post doc., PT, PhD Eva Jespersen
•  PT Vibeke Borggreen Winther, Svendborg
•  PT Anna Bonderup Hesby & PT Mads Bisgaard Borup

Department of Intensive Care Medicine, Aarhus University Hospital and AU. 

•  Co-supervisor: Associate Professor, RN, PhD Pia Dreyer

MedWare

•  Product Owner Jacob Glasdam & Projectcoordinator Malene Boe Broberg

Klinisk IT Odense University Hospital

•  Administrator 'MitSygehus', Jesper Hollegaard

Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, SDU 

•  Postdoc,Jan Christian Brønd