Early Rehabilitation in Critically Ill Children - The PICU Liber8 Study
Condition: Delirium; Withdrawal Syndrome; Hospital Acquired Condition; Critical Illness Myopathy; Critical Illness
MeSH terms: Critical Illness; Iatrogenic Disease; Substance Withdrawal Syndrome
Study type: Observational

Summary: 
      This is a pilot quality improvement implementation study that will measure the impact of a
      rehabilitation bundle implementation on the outcomes of interest. Advancements in the care
      provided in Pediatric Intensive Care Units (PICUs) have led to fewer deaths in children.
      These improvements are unfortunately countered by the emergence of side effects of critical
      illness, known as PICU-acquired complications (PACs). Delirium, muscle weakness, drug
      dependency and withdrawal are increasingly common. PACs occur because children are often
      over-sedated and experience long periods of immobilization. PACs delay recovery, increase
      disability and worsen long-term function and quality-of-life. Although they are preventable,
      PACs are very common and frequently overlooked by clinicians. This study aims to
      "liberate"children from critical illness and improve their recovery and functioning after
      discharge, through an innovative rehabilitation bundle of 8 complementary steps (PICU Liber8)
      to reduce sedation, allow children to awaken and breathe comfortably, encourage early
      mobilization, and engage families in their child's care.
    

Detailed description: 
      This is a pilot quality improvement implementation study that will measure the impact of a
      rehabilitation bundle.

      The objectives are:

        1. Primary - Implementation Objectives: to determine the feasibility and resources required
           to implement PICU Liber8 in 2 PICUs, evaluate strategies for successful bundle adoption.
           Co-Primary - Process Objectives: to determine the impact of PICU Liber8 on the process
           of care.

        2. Secondary Efficacy: impact on PACs and patient reported outcomes The methods consist of
           a PICU Liber8 Bundle Implementation Plan (Pronovost's 4 E's Framework), and measurement
           of the impact of Implementation through Orchestrated Testing (OT).

      For successful adoption of the PICU Liber8 bundle, the following are necessary:

        1. A context appropriate implementation framework.

        2. An implementation team leader.

        3. Inter-professional team engagement (i.e. RN, RT, MD, pharmacy, allied health and
           family).

        4. Ability to customize PICU Liber8 to the needs of each site. We will use the Pronovost's
           implementation framework, which has been shown to facilitate successful bundle adoption
           and improve the quality of patient care in adult and pediatric ICUs.17-19 This framework
           has 4 phases: Engage, Educate, Execute and Evaluate.
    

Intervention name(s): PICU Liber8 Bundle
Intervention type(s): Other
Intervention description(s): Bundle of elements for quality improvement
Other intervention name(s): implementation of strategy
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All patients admitted to the PICU for the QI intervention. For patient follow-up we will
        conduct for patients at risk (see eligibility criteria)
      
Keywords: rehabilitation; critical care; child health; quality improvement