82 Retrospective Analysis of the Utilization of a Multidisciplinary Algorithm for Mobilization of the Vented Burn Patient

Abstract Introduction In 2014, our multidisciplinary team developed a mobility algorithm to act as a guideline for the mobilization of vented burn patients, in order to maximize safety and efficiency. Stages of mobility were established to encompass the medical complexity of the burn patient. The guidelines were developed by a multidisciplinary team through review of existing literature. This multidisciplinary team became responsible for implementation of the mobility algorithm by January 2015. Methods A retrospective review of the burn center’s admission log was performed to identify all mechanically ventilated patients admitted from January 2015 to September 2017. Burn Therapy notes were then reviewed for the time period in which each patient was identified to be intubated via endotracheal (ET) tube. Stages of algorithm met during treatments were recorded. The data was then reviewed and compared to percentage of TBSA, hospital length of stay, and number of days requiring intubation. Results In the 33 months following initial implementation, the algorithm was utilized on 76 patients with an average TBSA of 22.7%. 10 of these patients were made comfort care measures due to the extent of their burn injuries, but were included in the study. The average intubated days were 7.6 days and the average length of stay was 28 days. No adverse events occurred during treatment with the algorithm. Stage 1: PROM/AROM were completed with 100% of patients (n=76). 37% (n=28) of patients progressed to stage 2a: Chair Mode of bed, while 12% (n=9) of patients were dependently transferred to the cardiac chair in stage 2b. 28% (n=21) transferred to the edge of bed, 13% (n=10) stood at the edge of the bed, and 7% (n=5) actively transferred to a chair by means of lateral stepping or stand pivot transfer. In 33 months, only 6% (n=5) reached Stage 6: Ambulation. The most common limitations to progress through the algorithm were femoral/pedal lines (21%) and medical complications including unstable medical status, orthopedic restrictions, sedation, agitation, and/or cultured epithelial autograft placement (33%). Conclusions During 33 months of implementation, 25% (n=21) of patients performed active mobility including stages 3–6 while intubated. Ultimately, retrospective analysis of the Vented Burn Patient Mobility Algorithm demonstrated that burn patients undergoing mechanical ventilation via ET tube could safely and efficiently progress toward independence with functional mobility