Walking Home From The ICU

Walking Home from the ICU
Translating the ICU with Stephen Ramsey Part 2: ICU Case Study
Guest: Stephen Ramsey, PT
In Part 2 with Stephen Ramsey, physical therapist and ICU mobility expert, the discussion dives into a complex cardiothoracic ICU case Stephen presented at APTA's CSM conference.

Using the MENTOR framework, Stephen walks through how rehab clinicians should approach critically ill patients — from chart review to interdisciplinary communication to real-time clinical decision-making.
A structured approach for PT/OT clinical reasoning in the ICU:
M – Map the Story: Thorough chart review and understanding the patient's full history
E – Expose the Unknowns: Identify gaps and questions before entering the room
N – Narrate Your Reasoning: Verbalize your clinical thinking to colleagues and the medical team
T – Test the Theory: Treat PT/OT as an assessment, not just an intervention — mobilize to observe physiologic response
O – Observe for Signals: Monitor real-time hemodynamic and respiratory responses
R – Review with the Team: Debrief after every session, whether it went well or not
Stephen walks Kali and the audience through a real case study using the MENTOR framework.

Walking Home from the ICU PodcastTranslating the ICU with Stephen Ramsey — Series 1, Episode 1
Episode Summary
Kali Dayton officially welcomes Stephen Ramsey — CVICU physical therapist, creator of the Ramsey Protocol, and lead author of the ELSO guidelines — as the newest member of the Dayton ICU Consulting team. In this kickoff episode of Translating the ICU, Kali and Stephen explore why physical therapists and occupational therapists are often rotating generalists in the ICU rather than dedicated specialists, and what needs to change to elevate rehab's impact on critically ill patients.
Key Topics Covered
​Introducing "Translating the ICU" — a new podcast series focused on physiology, pathophysiology, and critical thinking applied to real and theoretical ICU case studies
​CSM 2024 recap — Stephen’s talks on redefining PT's role in the ICU and point-of-care ultrasound; Kali's panel on what early mobility should actually look like
​The case for dedicated ICU rehab staffing — why rotating therapists undermine momentum, relationships, and patient outcomes
​PT/OT education gaps in critical care — invasive hemodynamics, pharmacology, diagnostic imaging, and ventilator management are largely absent from training
​Competency vs. potential — why redefining practice standards matters more than questioning individual intelligence or capability
​Mobility as a physiology test — Steven's framework for PT as "physiology tester," using mobilization to generate clinical data and drive medical decision-making
​Johnson 2019 data — dedicated CVICU PT/OT staffing increased from 2 to 4 clinicians → ICU length of stay decreased by 3.6 days
​The 2025 meta-analysis (60+ RCTs, ~8,500 patients) — timing matters more than intensity in early mobility
​Ventilator management and SBTs — why PTs need to understand spontaneous breathing trials and provide physiologic feedback before extubation decisions
​Building trust on the ICU team — demonstrating competency through relationships, not just credentials
​Barriers facing revolutionists — fear of mistakes, leadership pressure, staffing rotations, and how to push forward anyway
Resources & People Mentioned
- Steven Ramsey — @ThePOCUSPT | The Ramsey Protocol | ELSO Guidelines
​Kali Dayton — DaytonICUConsulting.com
​Christina Perme's ICU Rehab Course
​Heidi Engel & Jenna Hightower
​Johnson 2019 CVICU staffing study
​2025 early mobility meta-analysis (60+ RCTs)
Connect & Work With Us
​Consult with Kali on transforming your ICU's sedation and mobility practices → DaytonICUConsulting.com
​Coaching with Stephen Ramsey — one-on-one or team sessions for ICU rehab staff → www.DaytonICUConsulting.com and @ThepocusPT
​Online courses — coming soon from both Kali and Stephen
​Critical care ultrasound course for ICU clinicians — available now at ThePocusPT.com
Follow Kali on Instagram for open discussion, anonymous Q&A, and cross-disciplinary ICU conversations.

We know that the ABCDEF Bundle gives patients the best chance to survive and thrive. Yet, persistent hesitation regarding "increased RN workload and burden" remain significant barriers.

Is this belief true? Are sedation and immobility better, easier, and safer for nurses? Let's dive into Awake and Walking ICUs and what's in it for nurses.

Listen to more nurses share their comparison in workload and burden in episodes 76, 114, and 185!
Nursing Video  https://youtu.be/5zBdDVo2pyY?si=eDJxid0A5aWLwc0y
Interested in consulting, training, online courses and/or symposiums in your ICU? Check out www.DaytonICUConsulting.com!

Critical illness impacts not only the patient in the bed but also their entire family during and after the ICU. Eli and Cathy Garrison join us to share their young family's course of twists and turns of an amniotic fluid embolism to long-term disability.
Check out Cathy's podcast at: Birth Trauma Stories
www.DaytonICUConsulting.com

In this groundbreaking episode, Dr. Paul Wischmeyer returns to share the incredible developments in ICU nutrition and rehabilitation that are transforming patient recovery. As both a critical care physician and ICU survivor, Dr. Wischmeyer brings unique insight into what it takes to truly help patients recover from critical illness.www.DaytonICUConsulting.com

Get your CE credits from listening to this episode here: SapienCE