The Economic and Clinical Impact of Sustained Use of a Progressive Mobility Program in a Neuro-ICU.

OBJECTIVE: To investigate a progressive mobility program in a neurocritical care population with the hypothesis that the benefits and outcomes of the program (e.g., decreased length of stay) would have a significant positive economic impact. DESIGN: Retrospective analysis of economic and clinical outcome data before, immediately following, and 2 years after implementation of the Progressive Upright Mobility Protocol Plus program (UF Health Shands Hospital, Gainesville, FL) involving a series of planned movements in a sequential manner with an additional six levels of rehabilitation in the neuro-ICU at UF Health Shands Hospital. SETTING: Thirty-bed neuro-ICU in an academic medical center. PATIENTS: Adult neurologic and neurosurgical patients: 1,118 patients in the pre period, 731 patients in the post period, and 796 patients in the sustained period. INTERVENTIONS: Implementation of Progressive Upright Mobility Protocol Plus. MEASUREMENTS AND MAIN RESULTS: ICU length of stay decreased from 6.5 to 5.8 days in the immediate post period and 5.9 days in the sustained period (F(2,2641) = 3.1; p = 0.045). Hospital length of stay was reduced from 11.3 ± 14.1 days to 8.6 ± 8.8 post days and 8.8 ± 9.3 days sustained (F(2,2641) = 13.0; p < 0.001). The impact of the study intervention on ICU length of stay (p = 0.031) and hospital length of stay (p < 0.001) remained after adjustment for age, sex, diagnoses, sedation, and ventilation. Hospital-acquired infections were reduced by 50%. Average total cost per patient after adjusting for inflation was significantly reduced by 16% (post period) and 11% (sustained period) when compared with preintervention (F(2,2641) = 3.1; p = 0.045). Overall, these differences translated to an approximately $12.0 million reduction in direct costs from February 2011 through the end of 2013. CONCLUSIONS: An ongoing progressive mobility program in the neurocritical care population has clinical and financial benefits associated with its implementation and should be considered.

Prevalence of dependent loops in urinary drainage systems in hospitalized patients.

PURPOSE: The purpose of this study was to measure the prevalence and configuration of dependent loops in urinary drainage systems in hospitalized, catheterized adults. SUBJECTS: The study sample comprised 141 patients with indwelling urinary catheters; subjects were hospitalized at an academic health center in northern Florida. METHODS: We measured the prevalence of dependent loops in urine drainage systems and the incidence of urine-filled dependent loops over a 3-week period. We measured the heights of the crest (H(c)), trough (H(t)), and, when urine-filled dependent loops were present, the patient-side (H(p)) and bag-side (H(b)) menisci with a laser measurement system. All variables were measured in centimeters. RESULTS: The majority of observed urine drainage systems (85%) contained dependent loops in the drainage tubing and 93.8% of the dependent loops contained urine. H(c) and H(t) averaged 45.1 ± 11.1 and 27 ± 16.7 cm, respectively. Meniscus height difference (H(b) - H(p)) averaged 8.2 ± 5.8 and -12.2 ± 9.9 cm when H(p) < H(b)(65.3%) and H(p) > H(b) (32.7%), respectively. CONCLUSIONS: We found that dependent loops are extremely common in urinary drainage systems among hospitalized patients despite the manufacturer recommendations and nursing and hospital policies. Maintaining the urine drainage tubing free of dependent loops would require incorporation into nursing care priorities and workflow as inadvertent force on the tubing, for example, patient movement or nurse contact can change tubing configuration and allow excess drainage tubing to re-form a dependent loop.

Pediatric health care providers' knowledge of pulse oximetry.

Pulse oximetry monitors have become so commonplace in acute health care settings over the last decade that blood oxygen is now considered a "fifth" vital sign. This study assessed the knowledge base related to pulse oximetry technology and clinical interpretation of the data given. A total of 68 participants--nurses, respiratory therapists, and resident physicians at a large general pediatric unit of a children's hospital--completed a survey of open-ended questions. Preliminary analysis revealed that 84% of the clinicians felt they received adequate training; 84% correctly identified what a pulse oximeter measured; 40% correctly identified how a pulse oximeter worked, but only 15% had a correct understanding of the oxyhemoglobin dissociation curve. Clinicians identified a wide range of normal arterial oxygen saturation values and made numerous errors in evaluating saturation readings in hypothetical clinical situations. Although the majority of pediatric staff felt well trained and knowledgeable about pulse oximetry, there was a lack of knowledge of basic principles. The results of this study have implications for basic professional education programs and the orientation and ongoing education of pediatric health care providers.