Patients are often under the impression that hospitals want to get them up, moving and out quickly because of reimbursement restraints. While that might be true in many instances, more and more studies prove that early mobilization leads to better outcomes.
But the devil is in the details: how exactly do you get the sickest patients up and walking if they are still unsteady and tethered to ventilators, IVs and catheters?
Johns Hopkins Hospital (Baltimore) has invented a walker device to serve this particular need.
"In critical-care medicine, we've gotten better at improving mortality," Dale Needham, MD, an assistant professor in the division of pulmonary and critical care medicine at the Johns Hopkins School of Medicine, told Medical Device Daily. "As more patients survive, they commonly have persistent long-term impairments and stay in medical intensive care unit [MICU]."
He added, "Patients here get very heavy sedation and bed rest, and it contributes to muscle weakness and atrophy. Even after discharge, they have debilitating weakness and depression lasting weeks, months and sometimes even years. Our MICU wanted to move toward early mobility."
So Needham and a colleague asked students in a biomedical engineering design team course at Johns Hopkins University to devise a mobility aid for ICU patients. The students, supervised by faculty members and graduate students, and advised by hospital staff, invented a device called the ICU Mover Aid.
A standard walker just didn't work very well and required the assistance of four staffers: one to guide the patient, one to hold IV bottles, a respiratory therapist and a person following behind with a wheelchair in case the patient collapsed.
"It's very resource-intensive, but that's the current model," Needham said.
The ICU Mover includes all of the features of a standard walker, the safety features of a wheelchair, and a separate wheeled tower to which important life-support equipment can be attached.
The tower is designed to accommodate two oxygen tanks and three medical devices: a cardiac monitor, intravenous infusion pumps to provide medications, and a ventilator to support breathing. Despite all of the equipment attached to it, the Mover is small enough to maneuver through the MICU's narrow hallways, although using it in patient rooms, which are particularly small, proved to be more challenging.
Needham said the new Mover requires only two hospital staff members to accompany the walking patient.
Longer than a traditional walker, it also has a detachable nylon seat that can accommodate a patient up to 250 pounds and allows a physical therapist to get close to the patient. If the patient gets tired and needs to sit down, he or she can do so in the ICU mover, negating the need for somebody to push an emergency wheelchair behind.
"We ended up building three versions," said Joshua Lerman, a senior biomedical engineering student who served as team leader. "First, we used PVC pipes to work on the basic design. Then, we made an aluminum version. We made the final prototype mostly of steel. All through the process we got feedback from the hospital's ICU staff, who told us what we needed to change to make it better suit patients' needs. All of the staff involved in the ICU rehabilitation program was very happy with the final version."
At a recent competition for Johns Hopkins biomedical engineering design projects, the Mover's team took second-place honors.
Johns Hopkins has filed a provisional patent application for the device and the team is exploring commercialization opportunities.
Needham said much will depend on how quickly other hospitals adopt new therapies in the ICU setting to improve patient recovery. "With the increasing interest in early mobility for ICU patients and the emerging scientific evidence supporting the benefit of this approach," he said, "I think there is a strong commercial future for the Mover."
"We have identified a small group of companies and we are currently having some very early stage discussions," said Aditya Polsani, industry liaison at Johns Hopkins Office of Technology Transfer. "There's only a small group four to five ICUs in the U.S. that have already embraced this mobilization program. We're trying to determine if it makes sense to out-license the technology or keep it in house. We have to show the benefit of early mobility in intensive-care patients before any other hospital will embrace this device."