Sustained Early Mobility Gains in an Oncology ICU: A Two-Year Interdisciplinary Initiative

Introduction: Critically ill oncology patients face unique mobility barriers, including frailty, immunosuppression, and prolonged sedation. This quality improvement initiative aimed to promote a sustainable, interdisciplinary approach to early mobility and improve functional outcomes in a specialized oncology ICU.


Methods: A two-year quality improvement initiative was implemented in a specialized oncology ICU from October 2023 through August 2025. Strategies included structured mobility education, interdisciplinary rounding, shared governance, and nursing empowerment. Data were collected at six time-intervals and included: (1) percentage of patients mobilized, (2) discipline initiating mobility (RN, PT/OT, or both), (3) highest level of mobility achieved using the Johns Hopkins Highest Level of Mobility (JH-HLM) scale, and (4) average therapy session duration. Active mobility was defined as JH-HLM level ≥3. Chi-square tests were used to compare categorical distributions, the Cochran-Armitage test assessed linear trends in proportions, and one-way ANOVA was used to evaluate changes in therapy duration over time.


Results: Overall mobilization increased from 45.6% to a peak of 64.2%, stabilizing at 58.1% by August 2025. RN-led mobilization rose from 53.5% to 71.8% (p = 0.022), and PT/OT-led mobilization remained high across time points (p = 0.037). Interdisciplinary efforts involving both RN and PT/OT nearly doubled, increasing from 24.2% to 42.9% (p = 0.004), reflecting improved shared ownership. Among mobilized patients, active mobility (≥ level 3) improved from 69.1% to 83.4% (p < 0.001). Passive mobility (level 2) declined from 30.9% to 16.6%, while sitting/standing (levels 3–5) increased from 37.3% to 49.7%, and walking (levels 6–8) improved from 31.9% to 33.7%. Therapy engagement also improved: PT session duration increased significantly from 34 to 42.5 minutes, and OT peaked at 46 minutes before stabilizing at 39 minutes (both p< 0.001).


Conclusions: This two-year interdisciplinary initiative demonstrated sustained improvements and cultural transformation in ICU mobility practices through gains in active mobilization, therapy engagement, and shared ownership between nurses and therapists. These findings support the integration of early mobility as a core practice in complex oncology ICUs.