Early Mobility & COVID-19 | Improving Patient Outcomes

Early Mobility & COVID-19 | Improving Patient Outcomes

COVID-19 & IMPROVING PATIENT OUTCOMES

COVID-19 primarily attacks the lungs, and, although the virus itself is new, doctors are relying heavily on standard respiratory treatments (including early mobility) for the alleviation of COVID-19 symptoms and improving patient outcomes (WHO 2020). In the initial surge and amid the attempts to quarantine, early mobilization of COVID-19 patients was impossible to implement, but it has long been established that early mobilization of patients with severe respiratory infections activates the body’s own defenses, shortens length of stay, and significantly improves both short-and long-term patient outcomes.

The benefits of early mobilization for improving patient outcomes has been particularly well-documented for geriatric patients, who are at highest risk from COVID-19, and pediatric patients, who represent an increasingly significant percentage of COVID-19 patients. Now that there are dedicated COVID-19 wards and facilities, mobilization within a quarantined area is increasingly feasible and offers an immediate, proven, cost-saving option for saving lives and minimizing the burden for hospital staff.

Key Facts:

• The severity of COVID-19 is defined in the same progression as any other severe acute respiratory infection: pneumonia, severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis, and septic shock. The best-practice guidelines follow standard treatments for severe respiratory illness. (WHO 2020)
• For patients with community-acquired pneumonia, early mobilization (at least 20 minutes out of bed within 24 hours) can significantly reduce hospitalization time by an average of 1.5 days without increasing the risk of re-hospitalization. (Melgaard 2018, Pasikanti 2012)
• Several comprehensive reviews of best-practice treatment show that patient mobilization initiated shortly after the start of mechanical ventilation reduces both the total duration of mechanical ventilation and patient length of stay in ICUs. (Lai 2017, Hashem 2016, Schmidt 2016, Hruska 2016)
• A review of literature regarding early mobilization in pediatric ICUs reveals that early mobilization of critically ill patients is safe and widely beneficial. (Cameron 2015, Wieczorek 2015, Cuello-Garcia 2018) Early mobilization is particularly important for children because the stress of immobility combined with an unfamiliar environment, multiple caregivers, interrupted sleep, and limited environmental stimuli can cause children to regress in behavior and psychological development. (Owens 2018, Rennick 2014, Pinto, Choong 2017, Betters 2015).
• To limit the incidence of physical, cognitive, and psychological disabilities that can result from critical illness, the Agency for Healthcare Research and Quality strongly endorses early mobilization for all patients, whenever it is feasible (AHRQ 2017) because, for critically ill patients, early mobility is the only intervention proven to result in a decrease in days of delirium. (CIBS 2000, Barr 2013, Dirkes 2019, Krupp 2019, Taito 2016, Banerjee 2011, Schweickert 2009), which is important because there is a very strong correlation between delirium, increased length of hospital stay, development of cognitive impairment, and increased chance of death in adult ICU patients. (Barr 2013)
• When nurses and rehabilitation therapists were able to increase mobility by approximately 1 hour per ICU patient (for patients on ventilators and patients who were not), the average ICU length of stay decreased by almost 20%, floor bed average length of stay lowered by almost 40%, and twice as many patients were discharged without home services. (Corcoran 2017)

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