Improving quality of physical function assessment in intensive care units through routine use of the Danish Chelsea Critical Care Physical Assessment Tool (CPAx-D)

To improve the quality of physical function assessment through routine use of the Chelsea Critical Care Physical Assessment Tool (CPAx-D) in Danish ICUs. The methodological framework was “The Model for Improvement,” including the Plan-Do-Study-Act (PDSA) cycle. The context consisted of two ICUs at Aarhus University Hospital with 38 beds. Eligible patients were aged 18 years or older and considered stable and ready for physiotherapy treatment. Evaluation methods used were questionnaires, clinical practice observations, continuous feedback, status meetings, and an audit of the medical records including patients during a three-month period in the ICUs. The quality improvement process required three PDSA cycles and two years before CPAx-D was successfully implemented into clinical practice. The following barriers were identified; the COVID-19 pandemic increased workloads and caused reorganization of care; leave of absence of the project manager caused a lack of leadership; local instructions were not sufficiently aligned with practice; and detailed manuals were missing. A facilitator for implementation was the clinicians’ perception of CPAx-D as a meaningful tool, adding value to interdisciplinary collaboration and communication, and stimulated patient motivation. By employing various interventions, routine use of CPAx-D has been successfully implemented into clinical practice at two Danish ICUs. Early rehabilitation is crucial to reduce the physical consequences of intensive care admission.Routine use of standardized assessment instruments can support goal-setting, communication, and decision-making in rehabilitation of patients in the intensive care unit.This quality improvement study outlines the barriers and facilitators identified throughout the process of implementing routine use of the Chelsea Critical Care Physical Assessment Tool. Early rehabilitation is crucial to reduce the physical consequences of intensive care admission. Routine use of standardized assessment instruments can support goal-setting, communication, and decision-making in rehabilitation of patients in the intensive care unit. This quality improvement study outlines the barriers and facilitators identified throughout the process of implementing routine use of the Chelsea Critical Care Physical Assessment Tool.

为提升躯体功能评估质量，本研究通过在丹麦重症监护病房（Intensive Care Unit, ICUs）常规应用切尔西重症监护物理评估工具（Chelsea Critical Care Physical Assessment Tool, CPAx-D）开展质量改进工作。本研究采用“改进模型”作为方法论框架，涵盖计划-执行-研究-处理（Plan-Do-Study-Act, PDSA）循环。研究场景为奥胡斯大学附属医院的2个重症监护病房，总床位38张。纳入标准为年龄18周岁及以上、病情稳定且可接受物理治疗的患者。本研究采用的评估手段包括问卷调研、临床实践观察、持续反馈、现状会议，以及对该重症监护病房三个月内的患者病历开展审计。整个质量改进流程历经3次PDSA循环与2年时间，最终成功将CPAx-D应用于临床实践。本研究识别出以下实施障碍：新冠疫情加剧了工作负荷并导致护理工作重组；项目经理休假造成领导力缺失；本地指南与临床实践适配度不足；缺乏详细操作手册。本研究同时识别出实施促进因素：临床医师认为CPAx-D是极具意义的工具，可为多学科协作与沟通增添价值，并能提升患者治疗积极性。通过采取多种干预措施，CPAx-D的常规使用已成功在丹麦两家重症监护病房落地临床实践。早期康复对于减轻重症监护收治患者的躯体后遗症至关重要。常规应用标准化评估工具，可助力重症监护病房患者康复过程中的目标设定、沟通与决策制定。本项质量改进研究详细阐述了在常规推广应用切尔西重症监护物理评估工具的全过程中识别出的各类障碍与促进因素。早期康复对于减轻重症监护收治患者的躯体后遗症至关重要。常规应用标准化评估工具，可助力重症监护病房患者康复过程中的目标设定、沟通与决策制定。本项质量改进研究详细阐述了在常规推广应用切尔西重症监护物理评估工具的全过程中识别出的各类障碍与促进因素。