Implementing and sustaining an early rehabilitation program in a medical intensive care unit: A qualitative analysis

Michelle N Eakin; Linda Ugbah; Tamara Arnautovic; Ann M Parker; Dale M Needham

doi:10.1016/j.jcrc.2015.03.019

Implementing and sustaining an early rehabilitation program in a medical intensive care unit: A qualitative analysis

J Crit Care. 2015 Aug;30(4):698-704. doi: 10.1016/j.jcrc.2015.03.019. Epub 2015 Mar 21.

Authors

Michelle N Eakin¹, Linda Ugbah², Tamara Arnautovic², Ann M Parker³, Dale M Needham⁴

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA. Electronic address: Meakin1@jhmi.edu.
² Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
³ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
⁴ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.

PMID: 25837800
DOI: 10.1016/j.jcrc.2015.03.019

Abstract

Purpose: Early rehabilitation programs in a medical intensive care unit can improve patient outcomes, but clinicians face barriers in implementing and sustaining such programs. We sought to describe a multidisciplinary team perspective regarding how to implement and sustain a successful early rehabilitation program.

Methods: Semistructured interviews were conducted with 20 staff and faculty who were involved in the early rehabilitation program at the Johns Hopkins Hospital Medical Intensive Care Unit. Transcripts were evaluated using the Consolidated Framework of Implementation Research Theory.

Results: Four major constructs emerged as important, as follows: (1) necessary components, (2) implementation strategies, (3) perceived barriers, and (4) positive outcomes. All participants reported that staff buy-in was necessary, whereas having a multidisciplinary team with good communication among team members was reported as helpful by 90% of participants. The most common barrier reported was increased staff workload (80%). All participants (100%) noted improved patient outcomes as an important benefit, and 95% reported improved job satisfaction.

Conclusions: This qualitative study of a successful early rehabilitation program highlights the importance of assessing and engaging a multidisciplinary team before implementation and the positive outcomes of early rehabilitation on staff by improving job satisfaction and changing the culture of a hospital unit.

Keywords: Early rehabilitation; Implementation; Intensive care; Sedation.

MeSH terms

Adult
Attitude of Health Personnel
Communication
Critical Illness / rehabilitation*
Early Medical Intervention*
Female
Humans
Intensive Care Units*
Job Satisfaction
Male
Middle Aged
Program Development
Qualitative Research
Workload