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OACIS: Clinical Programs and Quality Improvement Projects


Critical Care Physical Medicine and Rehabilitation Program (CCPM&R)


This clinical program is designed to optimize intensive care unit patients' access to care and services that will improve their recovery process, including management of sedation, evaluation and management of delirium, improvement of sleep, and intensive and early rehabilitation therapy in the ICU settings.

Features include: early mobilization, cycling (cycle ergometer), Wii therapy, biomedical devices to assist with rehabilitation

Medical Director: Dale M. Needham, FCA, MD, PhD
Start date: 7/1/2009
Status: Currently ongoing


**NEW** Rehabilitation Psychology 

Rehabilitation Psychology specializes in assisting patients and families with adaptation to the ICU environment by providing education about psychological changes that occur during critical illness and strategies to cope with delirium, anxiety, and the process of recovery.

Selected Publications

  • Hosey MM, Jaskulski JJ, Wegener ST, Chlan LL, Needham DM. Animal-assisted intervention in the ICU: a tool for humanization. Critical Care. 2018 22:22. 
  • Hosey MM, Jaskulski JJ, Mantheiy EC, Kudchadkar SR, Wegener S, Needham DM. Animal-assisted activity in the intensive care unit. ICU Management & Practice. 2017;17(3):193-5.
  • Links: News articles and videos
Financial Model for Implementing an ICU Early Physical Rehabilitation Program
Lord RK, Mayhew CR, Korupolu R, Mantheiy EC, Friedman MA, Palmer JB, Needham DM. ICU early physical rehabilitation programs: financial modeling of cost savings.                                                        Critical Care Medicine 2013 Mar;41(3):717-24.                                                                               
  • ICUs with early physical rehabilitation programs have demonstrated decreases in length of stay, but formal financial analyses are often needed to justify the financial investment in these programs. This article and the associated Excel model can assist in conducting such financial analyses customized to a hospital’s unique situation.
  • Model (Excel 2007 or later)  /   User Guide
  • Publication

Johns Hopkins Activity and Mobility Promotion (AMP) Program 

Johns Hopkins implements strategies and approaches in its hospital units to foster engagement of all patients and staff in daily activity and mobility. The multi-disciplinary team discusses activity and mobility barriers and patient progression as part of standard hospital practices. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale is created to standardize the measurement and reporting of patient mobility in the hospital. The JH-HLM is currently being validated.  Anyone wishing to use this scale should submit a user request form. Link to JH-HLM & AMP

Co-Directors: Erik Hoyer, MD & Michael Friedman, PT, MBA
Status: Currently ongoing


ICU Physical Medicine and Rehabilitation

CCPMR 2009

Overall goal: To determine if intensive rehabilitation therapy for acute respiratory failure patients in the Johns Hopkins Medical ICU is feasible and associated with potential for improved short-term outcomes.

Outcome: This QI project demonstrated the feasibility of physical rehabilitation in mechanically ventilated MICU patients. Patients who otherwise would have been deeply sedated were awake and mobilized in the MICU while receiving mechanical ventilation (see photo at right). Comparison of MICU data from the QI project with the same 4 period in prior years demonstrates a substantial decrease in ICU length of stay. Publication

Links: News articles and videos

Sedation and Delirium

Changes in monitoring and management of sedation and delirium in the ICU aim to reduce the incidence and duration of delirium and allow patients' active participation in rehabilitation therapy. Sedation and delirium status are measured at least twice daily using the RASS sedation scale and CAM-ICU delirium screening tool. Participants actively work to identify and address the modifiable risk factors for delirium in the ICU. Publication

Sleep in the Intensive Care Unit

Intensive care unit (ICU)-associated sleep disturbances may have a negative effect on patient outcomes. Many interventions may help improve sleep in the ICU and associated patient outcomes. This QI project aims to make improvements in patients' sleep and related cognitive outcomes. Publication

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