In the ICU with Jessie Franco

The intensive care unit (ICU) is a specialized, fast-paced medical unit with the ability to provide comprehensive and specialized medical care, treatments, and continuous monitoring for critically ill patients.1,2 Approximately 4.1 million adults are admitted to the ICU each year with most surviving and requiring some form of rehabilitation.3 The ICU is staffed with multiple providers including medical doctors (MD), physician assistants (PA), nurses (RN), respiratory therapists (RT), occupational therapists (OT), physical therapists (PT), speech-language pathologists (SLP), registered dietitians (RD), case managers (CCRN), social workers (SW), and pharmacists.2 The combination of fast-paced environment and acuity of patient conditions requires specialized knowledge and training. The high consequence and urgent nature of care in the ICU relies on a well-coordinated team that can anticipate the role and responsibility of each care provider on the team. 

Intensive, early rehabilitation for patients in the ICU is safe, feasible, effective, and results in shorter ICU and hospital length of stays.4-13 Despite the evidence, early rehabilitation remains uncommon with only 45% of US hospitals implementing this as a standard practice of care.14,15 OTs remain consistently understaffed with only 34% of ICUs having dedicated OT and/or PT staff and only 40% of patients receiving OT during their ICU stay.16,17 Furthermore, many OT practitioners report feeling unprepared and overwhelmed by a lack of knowledge and experience when working in the ICU, negatively impacting their decision-making and clinical judgment.18-20 Additionally, other ICU providers are not accustomed to using OTs and are unaware of their role and benefit to the patient. This lack of knowledge may lead to a chronic and reduced presence of OT in the ICU, resulting in prolonged patient hospitalizations and impaired functional recovery.

In the ICU with Jessie Franco is an evidence-based resource for practitioners seeking to learn the knowledge and skills required to confidently work in the fast-paced and demanding ICU environment. As an OT, I’ve spent my professional career in the rehabilitation and acute care hospital settings. I’ve always been fascinated by the ICU setting and wanted to learn more about working with this critical population. In my quest for knowledge, I experienced firsthand the challenge of continued learning when support and mentorship are limited. And was further frustrated with siloing and, at times, limited knowledge sharing within the healthcare professions. 

As part of my post-professional doctoral project at MGH Institute of Health Professions, I sought to generate an innovative solution to this common practice problem. I took courses on ICU skills, read as much academic research as I could find, interviewed professional colleagues from across the United States, and then worked tirelessly to organize and synthesize this plethora of diverse information into this succinct website. Thus “In the ICU with Jessie Franco” was born! I hope this information is valuable to others, who like me, are curious and seeking the confidence to explore the ICU setting and I hope that they may continue to forge our path for expanding the diverse role of the OT into the ICU. 

References

  1. Clark, K. (2017). Intensive Care Unit. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational Therapy in Acute Care (2nd ed., pp. 115–135). AOTA Press. https://library.aota.org/OT_in_Acute_Care_2e/134?highlightText=intensive%20care%20unit

  2. Marshall, J. C., Bosco, L., Adhikari, N. K., Connolly, B., Diaz, J. V., Dorman, T., Fowler, R. A., Meyfroidt, G., Nakagawa, S., Pelosi, P., Vincent, J.-L., Vollman, K., & Zimmerman, J. (2017). What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care, 37, 270–276. https://doi.org/10.1016/j.jcrc.2016.07.015

  3. Weinreich, M., Herman, J., Dickason, S., & Mayo, H. (2017). Occupational therapy in the intensive care unit: A systematic review. Occupational Therapy In Health Care, 31(3), 205–213. https://doi.org/10.1080/07380577.2017.1340690

  4. Anekwe, D. E., Biswas, S., Bussières, A., & Spahija, J. (2020). Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: A systematic review and meta-analysis. Physiotherapy, 107, 1–10. https://doi.org/10.1016/j.physio.2019.12.004

  5. Bailey, P. P., Thomsen, G. E., Spuhler, V. J., Blair, R., Jewkes, J., Bezdjian, L., Veale, K., Rodriquez, L., & Hopkins, R. O. (2007). Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine, 35(1), 139–145. https://doi.org/10.1097/01.CCM.0000251130.69568.87

  6. Corcoran, J. R., Herbsman, J. M., Bushnik, T., Van Lew, S., Stolfi, A., Parkin, K., McKenzie, A., Hall, G. W., Joseph, W., Whiteson, J., & Flanagan, S. R. (2017). Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: An interprofessional performance improvement project. PM&R, 9(2), 113–119. https://doi.org/10.1016/j.pmrj.2016.06.015

  7. Falkenstein, B. A., Skalkowski, C. K., Lodise, K. D., Moore, M., Olkowski, B. F., & Rojavin, Y. (2020). The economic and clinical impact of an early mobility program in the trauma intensive care unit: A quality improvement project. Journal of Trauma Nursing, 27(1), 29–36. https://doi.org/DOI: 10.1097/JTN.0000000000000479

  8. Leditschke, I. A., Green, M., Irvine, J., Bissett, B., & Mitchell, I. A. (2012). What are the barriers to mobilizing intensive care patients? Cardiopulmonary Physical Therapy Journal, 23(1), 26–29.

  9. Morris, P. E., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., Ross, A., Anderson, L., Baker, S., Sanchez, M., Penley, L., Howard, A., Dixon, L., Leach, S., Small, R., Hite, R. D., & Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), 2238–2243. https://doi.org/10.1097/CCM.0b013e318180b90e

  10. Needham, D. M., & Korupolu, R. (2010). Rehabilitation quality improvement in an intensive care unit setting: Implementation of a quality improvement model. Topics in Stroke Rehabilitation, 17(4), 271–281.

  11. Pohlman, M. C., Schweickert, W. D., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bowman, A., Barr, R., McCallister, K., Hall, J. B., & Kress, J. P. (2010). Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Critical Care Medicine, 38(11), 2089–2094. https://doi.org/10.1097/CCM.0b013e3181f270c3

  12. Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bowman, A., Barr, R., McCallister, K. E., Hall, J. B., & Kress, J. P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. The Lancet, 373, 1874–1882. https://doi.org/DOI:10.1016/S0140- 6736(09)60658-9

  13. Sigler, M., Nugent, K., Alalawi, R., Selvan, K., Tseng, J., Edriss, H., Turner, A., Valdez, K., & Krause, D. (2016). Making of a successful early mobilization program for a medical intensive care unit. Southern Medical Journal, 109(6), 342–345. https://doi.org/10.14423/SMJ.0000000000000472

  14. Bakhru, R. N., McWilliams, D. J., Wiebe, D. J., Spuhler, V. J., & Schweickert, W. D. (2016). Intensive care unit structure variation and implications for early mobilization practices. An international survey. Annals of the American Thoracic Society, 13(9), 1527–1537. https://doi.org/10.1513/AnnalsATS.201601-078OC

  15. Winkelman, C., Higgins, P. A., & Chen, Y.-J. (2005). Activity in the chronically critically ill. Dimensions of Critical Care Nursing, 24(6), 281–290.

  16. Bakhru, R. N., Wiebe, D. J., McWilliams, D. J., Spuhler, V. J., & Schweickert, W. D. (2015). An environmental scan for early mobilization practices in U.S. ICUs. Critical Care Medicine, 43(11), 2360–2369. https://doi.org/10.1097/CCM.0000000000001262

  17. Prohaska, C. C., Sottile, P. D., Nordon-Craft, A., Gallagher, M. D., Burnham, E. L., Clark, B. J., Ho, M., Kiser, T. H., Vandivier, R. W., Liu, W., Schenkman, M., & Moss, M. (2019). Patterns of utilization and effects of hospital-specific factors on physical, occupational, and speech therapy for critically ill patients with acute respiratory failure in the USA: Results of a 5-year sample. Critical Care, 23(1), 175. https://doi.org/10.1186/s13054-019-2467-9

  18. Foreman, J. (2005). Occupational therapists’ roles in intensive care. OT Now, March/April, 15–18.

  19. Ohtake, P. J., Lazarus, M., Schillo, R., & Rosen, M. (2013). Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Physical Therapy, 93(2), 216–228. https://doi.org/10.2522/ptj.20110463

  20. Smith, K. (2020). Occupational and physical therapists’ knowledge and perceived confidence working in the intensive care unit. Journal of Acute Care Occupational Therapy, 3(1), 1–31.