Journal CME, December 2021: “Keep Your Move in the Tube” safely increases discharge home following cardiac surgery-“Keep Your Move in the Tube”

“Keep Your Move in the Tube” - article.pdf

Pdf Summary

The study conducted by Richard Gach and colleagues examined the impact of the "Keep Your Move in the Tube" (KMIT) approach compared to traditional restrictive sternal precautions in patients who underwent cardiac surgery via median sternotomy. Traditional precautions typically limit upper body movements to prevent sternal complications but lack robust evidence for their effectiveness and may hinder patient independence.<br /><br />The research was a before-and-after study conducted in a 600-bed acute care hospital. It compared outcomes among 1104 patients, with 627 receiving standard precautions and 477 following the KMIT approach, which allows greater freedom of movement guided by the patient's pain rather than strict weight and time limits.<br /><br />Key findings of the study include:<br /><br />1. **Increased Discharges to Home**: Patients in the KMIT group were three times more likely to be discharged home rather than to an inpatient rehabilitation or skilled nursing facility.<br />2. **Enhanced Functional Status**: KMIT patients showed significantly higher odds of achieving "independent" or "modified independent" functional status in bed mobility and transfers by the end of their inpatient physical therapy sessions.<br />3. **No Increase in Complications**: There was no significant difference in the incidence of sternal wound complications or 30-day readmissions between the KMIT group and those following standard precautions.<br />4. **Shorter Physical Therapy Duration**: More KMIT patients had their physical therapy discontinued before discharge, indicating faster recovery.<br /><br />In summary, the KMIT approach safely facilitated earlier discharge to home, improved functional outcomes, and did not increase the risk of sternal wound complications or 30-day readmissions. This approach promotes independence and could potentially reduce healthcare costs by decreasing the need for extensive postacute care. Further research via randomized controlled trials is recommended to validate these findings.

Keywords

Keep Your Move in the Tube

KMIT

sternal precautions

cardiac surgery

median sternotomy

functional status

discharge to home

physical therapy

sternal wound complications

healthcare costs