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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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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

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

Divya Manikandan, Hallie Lenker, Colleen Mennie, Stephanie Morgenstern, Sukaina Furniturewala, Lisa Hwang, Krista Hajnik, Kristen M Brown, Nicole Shilkofski, Sapna R Kudchadkar, Jessica M LaRosa

Divya Manikandan, Colleen Mennie, Sukaina Furniturewala, Lisa Hwang, Nicole Shilkofski, Sapna R Kudchadkar, Jessica M LaRosa, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States

Hallie Lenker, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States

Stephanie Morgenstern, Department of Pediatric Nursing, Charlotte R. Bloomberg Children’s Center, Johns Hopkins Hospital, Baltimore, MD 21287, United States

Krista Hajnik, Department of Respiratory Therapy, Charlotte R. Bloomberg Children’s Hospital, Johns Hopkins Hospital, Baltimore, MD 21287, United States

Kristen M Brown, School of Nursing, Johns Hopkins University, Baltimore, MD 21287, United States

Author contributions: Manikandan D designed and conducted the quality improvement initiative and wrote the manuscript. Lenker H, Morgenstern S, Hajnik K, Brown KM, Shilkofski N, and Mennie C contributed to the initiative design; Mennie C, Furniturewala S, and Lisa H collected data. Kudchadkar SR and LaRosa JM participated in the design and supervision of the initiative, and LaRosa JM also took part in data collection.

AI contribution statement: AI tools (specifically Claude) were used for the generation of Figure 2, and Supplementary Table 2. Forest Plots and tables were originally generated using STATA software and uploaded to Claude for the creation of editable forest plots and tables in PowerPoint format. AI was not involved in the analysis of the data, and all outputs were verified by the authors.

Supported by the National Center for Advancing Translational Sciences, No. KL2TR003099.

Institutional review board statement: This project was designated as a quality improvement initiative by our institutional review board and was reviewed and acknowledged as exempt, No. IRB00289007.

Informed consent statement: Our study was deemed exempt by the Johns Hopkins Medicine Institutional Review Board (No. IRB00289007). As such, it was given the designation of non-human subjects research/quality improvement, and informed consent was not required.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: This quality improvement project received an acknowledgement as not human subjects research by the IRB; therefore, we do not have consent for data sharing.

Corresponding author: Jessica M LaRosa, MD, Assistant Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Suite 6349, Baltimore, MD 21287, United States. jlarosa4@jhmi.edu

Received: April 20, 2026
Revised: May 26, 2026
Accepted: June 5, 2026
Published online: September 9, 2026
Processing time: 125 Days and 20.1 Hours

Core Tip

Core Tip: This initiative found substantial discordance between protocol-expected, health record documented, and nurse-reported mobilizations in a pediatric intensive care unit with a 12-year early mobility program. Nursing uncertainty regarding mobility levels frequently resulted in patients being mobilized at a level lower than the target. Severe disability at baseline, rather than mechanical barriers like medical equipment, was associated with discordance between nurse-reported mobility and the protocol. Early mobility protocols should be modified to include unambiguous guidance for children with baseline medical complexity, and programs should assess implementation fidelity and program efficacy to ensure safe and consistent mobilizations of critically ill children.