Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative

doi:10.5492/wjccm.122427

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World Journal of Critical Care Medicine

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2220-3141

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Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Crit Care Med. Sep 9, 2026; 15(3): 122427
Published online Sep 9, 2026. doi: 10.5492/wjccm.122427

Table 2 Mobilization data as reported by electronic health record, nurse report, and expected values, n (%)

PICU Up! level	EHR¹	RN-report²	Expected
Level 1	13 (12.9)	9 (8.9)	24 (23.8)
Level 2	26 (25.7)	13 (12.9)	23 (22.8)
Level 3	48 (47.5)	51 (50.5)	54 (53.5)
Undocumented/unknown	14 (13.9)	28 (27.7)	0 (0)
Highest level of mobility achieved	EHR³	RN-report⁴
Bedrest or passive movement	54 (53.5)	34 (33.7)	28 (27.7)
In-bed activities	8 (7.9)	14 (13.9)	19 (18.8)
Out-of-bed activities	14 (13.9)	31 (30.7)	24 (23.8)
Standing or ambulating	25 (24.8)	22 (21.8)	30 (29.7)
Number of nurse-led mobilizations per shift (median, IQR)	1 (2)	6 (2)	6 (0)
Potential safety event rate per mobilization	0.02 (2/101)	0.02 (12/606)	0 (0)

¹Agreement in PICU Up! level between electronic health record and expected - 56.4%; κ = 0.34.

²Agreement in PICU Up! level between registered nurse report and expected - 53.5%; κ = 0.32.

³Agreement in highest level of mobility between electronic health record and expected - 39.6%: κ = 0.17.

⁴Agreement in highest level of mobility between registered nurse report and expected - 40.6%: κ = 0.20.

PICU: Pediatric intensive care unit; EHR: Electronic health record; RN-report: Registered nurse report; IQR: Interquartile range.

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Citation: Manikandan D, Lenker H, Mennie C, Morgenstern S, Furniturewala S, Hwang L, Hajnik K, Brown KM, Shilkofski N, Kudchadkar SR, LaRosa JM. Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative. World J Crit Care Med 2026; 15(3): 122427
URL: https://www.wjgnet.com/2220-3141/full/v15/i3/122427.htm
DOI: https://dx.doi.org/10.5492/wjccm.122427

Manikandan D, Lenker H, Mennie C, Morgenstern S, Furniturewala S, Hwang L, Hajnik K, Brown KM, Shilkofski N, Kudchadkar SR, LaRosa JM. Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative. World J Crit Care Med 2026; 15(3): 122427 [DOI: 10.5492/wjccm.122427]

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