IMPLEMENTATION OF ANOUTCOME MEASUREINTO ICU

Thomas BondSenior PhysiotherapistWellington HospitalCapital & Coast DHB

OBJECTIVES

|Why needed an outcome measure?|What is the outcome measure?|How we implemented it|What changes we made|Re-audit|Staff survey|Patient view

WHY DID WE NEED ANOUTCOME MEASURE?

ICU OUTCOME MEASURES

WHY CPAX?(CHELSEA CRITICAL CARE PHYSICAL

ASSESSMENT TOOL)

CHELSEA PHYSICAL ASSESSMENT TOOL(CPAX)

19

12

3

4

56

7

8

9

10

CPAX TOOL

Ceiling effect

Floor effect

3 / 50

0.8%

3.2%

True change

HOSPITAL DISCHARGE BASED ON CPAX

Corner et al 2014

HOW DID WE IMPLEMENT IT?

PILOT OBJECTIVES

Time burden

Tests per patient

Assist with physiotherapy

assessment or treatment

INCLUSION CRITERIA

Requiring mechanical ventilation for >48 hours

ICU stay of >72 hours

Consultant diagnosis of ICU-acquired weakness

RASS between +2 and -2

WHAT WERE THE RESULTS?

3 months417

admitted 59 included125 CPAx

tests2.1 tests per

patient

3.9 days 21.6 days

Mean assessment

time

33.6%

19.4/50

20 mins

Useful CPAx tests

Mean CPAxScore

FURTHER ANALYSIS

RICHMOND AGITATION ANDSEDATION SCORE

Score Descriptor+4 COMBATIVE+3 VERY AGITATED+2 AGITATED+1 RESTLESS0 ALERT & CALM-1 DROWSY-2 LIGHT SEDATION-3 MODERATE

SEDATION-4 DEEP SEDATION-5 UNAROUSABLE

WHAT DID WE CHANGE?

CHANGES TO IMPLEMENTATION

RASS between +1 & -1

Long term patients (≥5 days)

Physiotherapy discretion for use

RE-AUDIT RESULTS

Admission to first CPAx

Average length of

stayAverage

CPAx tests

Average RASS 0

20 days

2.4 tests

11.6 days

PROGRESS OF PATIENTS

Theatre Theatre

Reintubatedand trache

Theatre

STAFF SURVEY

RESULTS

78% response rate (39/50)

64% of nurses aware of CPAx

26% found CPAxhelped motivate / monitor progress

of patients

87% involved in long-term patient

care

PATIENT’S THOUGHTS

FEEDBACK FROM ONE PATIENT

HOW DOES IT HELP YOU?

|Follow patients progress|Visual representation|Easy to use|Training package already in place|Low floor and ceiling effects|Quick idea of patients functional status|Discharge destination predictor

GOING FORWARD.....

WITH THANKS TO....|Daniel Seller (Physiotherapist)|ICU Staff|Cardiorespiratory Physiotherapists at

CCDHB|Lisa Woods (for statistical analysis)|Physiotherapy Team Leader (for

funding of dynamometer)

REFERENCES

| Corner EJ, Handy JM, Brett SJ. 2016 eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment: a novel measure of function in critical illness. BMJ Open

| Corner EJ, Hichens LV, Attrill KM, Vizcaychipi MP, Brett SJ, Handy JM 2015 The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: An observational study. Burns 41(2)241-247

| Corner EJ, Soni N, Handy JM, Brett SJ 2014 Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness. Critical Care 18(2)R55

| Corner EJ, Wood H, Englebretsen C, Thomas A, Grant RL, Nikoletou D, Soni N 2013 The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy 99:(1)33-41