Implementation of an early mobility protocol in the neuroscience ICU


  • Jessica S. Jarvis, MSN, APRN, AGACNP-BC, CNRN, SCRN Duke University
  • Robert Blessing, DNP, ACNP Duke University
  • Colleen Naglee, MD Duke University Hospital
  • Staci S. Reynolds, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN, CPHQ Duke University School of Nursing



neurocritical care; progressive mobility; nurse; quality improvement



Background: Early mobility is a safe and effective intervention to improve patient outcomes in the neuroscience intensive care unit (ICU). However, mobilization of patients in a neuroscience ICU within an academic medical center was suboptimal, with less than 36% of patients achieving their highest level of mobility.

Aim: The purpose of the quality improvement project was to develop and implement a multidisciplinary early mobility protocol, including a safety-screening tool.

Methods: Iterative Plan-Do-Study-Act cycles were implemented from April to August 2022. The screening tool assisted nurses in assessing the patient’s eligibility for early mobilization. A mobility section addressing patient-specific mobility screening, barriers to mobility, and a daily mobility plan was added to the provider note templates. Baseline data were collected from September to November 2021; post-implementation data were collected from April to August 2022.

Results: There was a reduction in the mean time between admission to the first documented out of bed activity from 3.24 to 2.01 days, p=.061. The mean number of documented out of bed activities significantly increased from 6.13 to 8.35, p = .002. Hospital length of stay significantly decreased from 19.8 to 12.42 days, p=.006.

Conclusions: Implementing an early mobility screening tool and protocol in the neuroscience ICU increased mobility for patients with neurological diagnoses. Other hospitals should consider implementing a similar process to help improve patient outcomes.




How to Cite

Jarvis, J., Blessing, R., Naglee, C., & Reynolds, S. (2023). Implementation of an early mobility protocol in the neuroscience ICU. International Journal of Critical Care, 17(3), 115–127.

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