Using hospital administrative data, we aimed to evaluate the effect of the QI project, across all MICU patients, on the number of PT and OT consultations/treatments and length of stay, in comparison with the prior year. This multifaceted QI project was conducted TSA HDAC using a structured QI framework and evaluated using a before/after design. The initial phases of the QI project (ie, the “engage” and “educate” processes, as described in the Quality Improvement Process section) started in spring 2006 with increasing intensity until the 4-month “execution” phase (May to August 2007), during

which early PM&R was implemented. For purposes of the before/after comparison, this execution phase is referred to as the “QI period” Epigenetic inhibitor and is compared with the immediately preceding 3-month pre-QI period (February to April 2007). During the entire 7-month combined pre-QI and QI periods, prospective collection of relevant data occurred for the target patient population. To further evaluate the overall effects of the QI project on all MICU patients, data regarding the number of PT and OT consultations/treatments and LOS were obtained from hospital administrative data to compare the QI period with the same 4-month period

in the prior year (ie, May to August 2006). The prior year was used in this latter comparison in order to control for known seasonal effects on the number of MICU Teicoplanin admissions and LOS. The MICU at our hospital has 16 beds and is staffed with attending, fellow, and resident physicians and registered nurses (staff-to-patient ratio1:2) and respiratory therapists (staff-to-patient ratio 1:8). Neurology consultation and PT and OT are available when ordered by an MICU

physician. Physiatry consultation did not occur while patients were in the MICU. In the MICU, “bed rest” was the prescribed activity level in standard admission orders, and there were no MICU guidelines for consultation or treatment by a PT or OT. Routine nursing care included repositioning patients in bed every 2 hours and the use of standardized pain and sedation scales, with a nurse-titrated sedation protocol and a daily reduction in sedation infusions.19 Standardized assessments for delirium in the MICU were not part of routine nursing care. In both the pre-QI and QI periods, we targeted prospective data collection regarding patients’ baseline status and outcomes for the patients who we felt would derive the greatest benefit from increased PM&R therapy.