Cleveland Clinic ICU Project Prioritizes “Movement as Medicine” to Accelerate Recovery
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A new initiative at Cleveland Clinic Avon Hospital is transforming intensive care, emphasizing the critical role of early mobility in patient recovery and overall well-being. The program, launched in 2023, is demonstrably improving patient outcomes and reducing hospital stays by actively engaging patients and their families in the healing process.
The Vital Link Between Mobility and Recovery
Mobility isn’t simply about physical movement; it’s fundamental to overall health, according to a leading clinical nurse at the hospital. “Mobility impacts every single part of your existence,” she explains. “It is essential for everything from kidney and liver function to muscle and bone health.” Recognizing this, the team at Avon Hospital sought to move beyond traditional, passive care for critically ill patients.
From Delirium Management to Proactive Mobilization
The project’s origins lie in a broader effort to improve care within the ICU. A year before the mobility initiative, an interdisciplinary team – including nurses, physical and occupational therapists, a speech language pathologist, a physician assistant, and a respiratory therapist – formed to address delirium management using the A2F ICU Liberation Bundle. This bundle focuses on six key elements: Assess, prevent and manage pain; spontaneous awakening and breathing trials; choice of analgesia and sedation; delirium assessment, prevention, and management; early mobility and exercise; and family engagement and empowerment.
The team quickly realized the power nurses held in implementing the latter half of the bundle. “We don’t have control of patient airways and sedation, but nurses do own the back end of the A2F bundle,” a senior nurse stated. This realization paved the way for a dedicated focus on early mobilization and active family participation.
Empowering Caregivers with Tools and Education
To facilitate this shift, the hospital adopted the 6-clicks mobility score, a validated assessment tool used by nurses and physical therapists to gauge a patient’s functional mobility. Based on this score, Maria Mepham, PT, DPT, manager of Rehabilitation Services at Avon Hospital, developed four tiers of exercises, ranging from caregiver-assisted movements for patients with limited mobility to more independent exercises for those with higher scores.
Initially, exercise instructions were provided in binders within each patient room. However, feedback from the ICU Shared Governance Committee led to a more accessible solution: a centralized resource center in the hallway, allowing caregivers to quickly locate the appropriate exercise grouping for each patient.
Mobility Carts: A Rolling Resource for Recovery
Further enhancing accessibility, Cheryl Mooney, BSN, RN, and Mepham spearheaded the creation of dedicated mobility carts for each of the 12 ICU rooms. These carts, equipped with essential tools like exercise bands, gait belts, and weighted PVC bars, alongside walkers, provide everything needed to encourage movement. A laminated “Movement Is Medicine” letter attached to each cart reinforces the importance of mobility and offers practical tips for family involvement.
“Families love it. It gives them something to do while their loved ones are hospitalized and makes them part of the care,” Mooney says. “Our goal is to encourage safe and appropriate movement daily.”
Investing in Nurse Education for Sustainable Change
Recognizing that successful implementation hinged on staff buy-in, the team prioritized comprehensive education for ICU nurses. A dedicated letter highlighted the benefits of early mobilization, offering guidance on family inclusion, patient acuity considerations, and incorporating activities of daily living into exercise routines. Mooney shared project details during morning huddles and governance meetings, while Mepham and Nicole Kodman, OTR/L, senior occupational therapist, provided individualized training and demonstrated the use of the mobility cart contents.
“There was a lot of collaboration with nurses from the day and night shifts, getting their input and buy-in,” Mooney noted.
A Lasting Impact on Patient Care
More than two years after its launch, the mobility initiative remains a cornerstone of care in the ICU. The project has demonstrably contributed to shorter ICU stays and increased bed availability. However, the benefits extend far beyond logistical improvements.
“It helps get patients out of the ICU sooner, and it opens up bed space for the next patient,” Mooney explains. More importantly, she emphasizes, early mobilization is “simply the right thing to do.”
“These people did not spend their lives flat on their back having people do things for them. Every single person in our ICU came in with a life, and they deserve the opportunity to get back to that life,” Mooney concludes. “Mobilization is one of the best tools we have to help them.”
