ArticleWorld journal of critical care medicine2026
Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative.
Article in World journal of critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly mobility in the pediatric intensive care unit (PICU) is safe and associated with improved cognitive and functional outcomes while reducing complications and hospital length of stay. Protocolized early mobility programs guide activity based on physiologic criteria and increase mobilization rates. However, critically ill children remain under-mobilized. Nurses, key agents of mobility implementation, continue to report barriers even when protocols are in place, yet the extent to which these barriers contribute to deviations from early mobility protocols remains unknown.
aimTo evaluate discrepancies between nurse-reported mobility, electronic health record documentation, and early mobility protocol expectations in the PICU.
methodsWe conducted an observational study evaluating nursing-led mobility in 101 patients admitted ≥ 3 days to a large, academic PICU. Key variables included physiologic mobility level (1 = most restrictive to 3 = most liberal), the highest level of mobility (HLM) achieved, and the number of mobilizations. Data were obtained from the electronic health record, end-of-shift nurse interview [registered nurse report (RN-report)], and compared with protocol-expected mobility using Cohen's Kappa. Firth penalized logistic regression assessed age, pediatric risk of mortality score, and pediatric cerebral performance category as predictors of discordance.
resultsAgreement between protocol-expected and RN-reported mobility level was moderate (53.5%;
conclusionIn a longstanding PICU mobility program, discordance exists between protocol-expected and RN-reported mobility. Severe baseline disability increases this discordance, highlighting the need to evaluate the fidelity of early mobility programs.
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