There is a growing body of evidence demonstrating early mobilization for critically ill
children is safe and feasible. Occupational therapists and physical therapists have distinct skills
and abilities which make them an integral part of an interdisciplinary early mobilization program
in the pediatric intensive care unit (PICU). The incorporation of occupational therapy and
physical therapy services in an early mobilization program assists in decreasing the negative
effects of immobility and inactivity through the facilitation of active movement and participation
in age appropriate functional activities. Despite consults being placed within 72 hours of
admission in the PICU at Cincinnati Children’s, barriers existed which impacted the ultimate
delivery of OT and PT services to patients. The purpose of this study was to assess whether the
desired improvement in the delivery of occupational therapy and physical therapy services in the
PICU was achieved when interventions were applied using quality improvement methodology. A
quality improvement approach, guided by Cincinnati Children’s rapid cycle improvement
collaborative roadmap, aimed to identify whether interventions applied during a 120 day quality
improvement project were effective in transforming the care delivery processes for therapy
services in the PICU at a single institution as measured by the ability to produce a 20%
improvement in the percentage of scheduled occupational therapy and physical therapy
treatments which were delivered. The PICU population included in this quality improvement
project consisted of patients with (1) an occupational therapy and physical therapy consult, (2) a
scheduled occupational therapy and/or physical therapy appointment, and (3) a bed on the PICU
floor. The study period was from December 18, 2018 through April 16, 2019. Adoption of
several interventions increased the median percentage of scheduled occupational therapy and
physical therapy treatments which were delivered from 48.6% at baseline to 56%.