ICU recovery programmes may offer benefits across the entire critical illness journey, for both clinicians and patients. |
Introduction
Methods
Setting and ethical approval
Study design
Participants, sampling and recruitment
Data collection and generation
Data analysis and rigor
Role of the funder
Results
ICU follow-up clinic (n = 15, participants) | Peer support (n = 13, participants) | |
---|---|---|
Age (years), mean (SD) | 41.3 (8.6) | 44.1 (8.7) |
Gender, n (%) male | 7 (46.7) | 3 (23.1) |
Years of practice in critical care (years) Mean (SD) | 11.1 (6.9) | 16.3 (10.4) |
Discipline, n (%) | ||
Medical | 8 (53.3) | 6 (46.2) |
Nursing | 2 (13.3) | 4 (30.8) |
Pharmacist | 4 (26.7) | 1 (7.7) |
Allied health | 1 (6.7) | 2 (17.4) |
Sites represented, n (%) of total collaborative sites | 10 (100) | 11 (73)a |
Formal/organizational mechanisms to drive improvements back into the ICU
Clinic: “When I’m on service, I scrutinize the discharge summaries to make sure they remember to say put a stop date for the anticoagulation, for the DVT.”
Peer Support:”…A letter to the General Practitioner (GP) explaining that the patient has had an ICU stay and that they may be experiencing some aspects of Post Intensive Care Syndrome (PICS).”
Peer Support: “…Little things like the ‘all about me’ boards. So I like to be called this, when I’m not in the intensive care unit I enjoy doing this, etc. I know a lot of places had these already, we hadn’t quite got to doing that till we got the feedback from patients and relatives.”
Peer Support: “One patient and his wife came to the hospital grand round and talked about their experiences and there were 150 people in the audience, and it was quite amazing that they did that… it was good for them, they enjoyed the experience, they felt like they were helping, and giving something back.”
Peer Support: “We’ve had one or two people volunteering for shifts on the ICU, just answering the door, and showing people in, that kind of stuff.”
Peer Support: “we’ve heard from our support group, that they can come back to the ICU and be that inspiring person.”
Clinic: “We’ve invited a lot of clinicians from the floor to see what we do and the things that we initiate through our own clinic… which is a great thing.”
Clinic: “…Sometimes there’s a push on palliative care, but sometimes you have a young otherwise healthy reversible disease and people are trying to push toward palliative care a little early… So showing, I think from an education and trainee standpoint, that these folks actually do get out, maybe having them see some of the patients in the clinic too, but just at least giving the stories back to them is helpful.”
Clinic: “Our pharmacist has said it’s been really helpful [working in clinic] because that affected his influence, his practice within the ICU and it’s the same for us…”
Informal/intra-clinician mechanisms to drive improvements back into the ICU
Clinic: “Seeing patients post-ICU has made me a better intensivist. It’s not just the training; it’s made me much more aware of things that I never gave thought to. Passing an NG tube and how excruciating that might be…”
Clinic: “The big plus for me has been watching people get better and watching them want to help.”
Peer Support: “We can start the ball rolling before they actually leave intensive care. If we can predict that they’re going to be in for a while we get their benefits sorted.”
Clinic: “…It’s clearly a service that’s required because every patient that I speak to, or relative, goes; I’m so pleased you phoned. There’s a sort of relief that someone is there to help them, because there is nothing and they’re just popped out in the ocean to sink or swim.”
Clinic: “Staff morale’s been boosted because of the feedback to nurses, a lot of nurses have responded saying……hearing they’re making progress has been really helpful.”
Peer Support: “And just appreciating that you hear about the struggles of maintaining home, life, work, and transportation and how if it’s an hour and a half to get to the hospital, and the financial burden as well. It just meant that in my conversations with updating families I ask now a lot earlier how far have you got to travel, do you want accommodation at the hospital?”
Peer Support: “People are saying things like thank god I found this site, I’m so glad to know I’m not the only one. A lot of people are saying that ‘I’m not alone; I thought I was going crazy, I’m so glad I found this forum.’”