Introduction
Materials and methods
The Healthtalkonline project (formerly DIPEx)
The sample
Interview number | Age (years) | Sex | ICU/HDU stay * | Ward stay* | ICU follow-up care* |
---|---|---|---|---|---|
IC01 | 41 | F | ICU: 11 days | 2 weeks | Regular appointments with clinical psychologist |
IC02 | 60 | M | ICU: about 1 month | 4 days | Attended initial appointments, declined future appointments |
IC03 | 66 | M | ICU: 5 weeks | 5 weeks | 1 appointment |
IC04 | 46 | F | ICU: about 5 weeks HDU: 1 week | Discharged after 1 week in HDU | 2 appointments |
IC05 | 40 | F | ICU: 22 days HDU: 10 days | Just over a week | 1 appointment |
IC06 | 35 | F | ICU: 3 weeks HDU: 36 hours | 5 weeks | 2 appointments and private counselling |
IC07 | 60 | M | ICU: 7 months | Ward: 1 month Home: awaiting rehab | None at time of interview |
IC08 | 50 | M | ICU: 10 days | Readmitted in 2006 and died | N/A |
IC09 | 60 | M | ICU: 3 days | 10 days | No ICU follow-up |
IC10 | 76 | F | ICU: about 1 week | 1 week | 1 appointment |
IC12 | 23 | F | ICU: 21 days HDU: 2 weeks | 2 weeks | Had been invited to attend 1st appointment |
IC14 | 35 | F | ICU: 2 days | 2 days, discharged herself | Declined appointment |
IC15 | 38 | F | ICU: 1 month, admitted 3 times in 2004 | Several months on and off | No ICU follow-up |
IC16 | 67 | M | ICU: 8 weeks | 3 weeks | No ICU follow-up |
IC17 | 30 | M | ICU: 12 days | 2 weeks | No ICU follow-up |
IC18 | 62 | M | ICU: 18 days | 5 weeks | 2 appointments |
IC21 | 72 | M | ICU: about 4 weeks | 1 week | No ICU follow-up |
IC22 | 71 | M | ICU: 17 days | A few days | At least 1 appointment |
IC23 | 54 | M | ICU: 17 days | 2 weeks | 1 appointment |
IC24 | 44 | F | ICU: 5 weeks | 2 weeks | Physiotherapy referral after 1st appointment, GP referral for counselling |
IC25 | 45 | M | ICU: 4 weeks | 2 weeks | 2/3 appointments |
IC26 | 47 | M | ICU: 30 days | 8 days | No ICU follow-up |
IC27 | 68 | M | ICU: 2 weeks HDU: 2 weeks | Ward: 6 weeks; Rehab: 2 weeks | 1 appointment |
IC28 | 46 | M | ICU: 7 weeks | 4 weeks | 1 appointment |
IC29 | 47 | F | ICU: 2 weeks HDU: 1 day | 1 week | 1 appointment, another expected |
IC30 | 55 | F | ICU: 6 days HDU: 5 days | Discharged after HDU | 2 appointments |
IC31 | 71 | M | ICU: 2 weeks | 3 weeks | At least one appointment |
IC32 | 57 | F | ICU: 29 days | Ward: 6 weeks Rehab: 6 weeks | 3 appointments |
IC34 | 37 | M | ICU: 30 days total, admitted twice | Several months | At least one appointment |
IC35 | 33 | M | ICU: 17 days | Ward: 1 week Rehab: 3 months | At least one appointment |
IC36 | 67 | F | Could not remember | Awaiting 1st appointment | |
IC37 | 58 | M | ICU: 9 days | 16 days | At least 1 appointment |
IC38 | 55 | F | ICU: 1 week | 2 weeks | 1 appointment |
IC39 | 56 | M | ICU: 4 days | 3 days | No ICU follow-up |
Reasons for admission |
Emergency admissions |
Planned admissions |
Coming round and regaining consciousness |
Sleep, dreams and hallucinations |
Intensive care treatments |
Physiotherapy |
Emotional experiences in the intensive care unit (ICU) |
Nursing care in ICU |
Death and bereavement |
High dependency units (HDU) |
Experiences in the general ward
|
The general ward: care and environment |
Physical and emotional experiences |
Physiotherapy on the ward |
Discharge and moving on |
Recovering at home
|
Physical recovery |
Emotional aspects of recovery |
Making sense of what happened |
Information |
Information for people admitted to ICU for emergency treatment |
Information: planned admissions |
ICU follow-up care |
Attitudes to life during and after recovery |
Effects on family |
Effects on work |
Sources of support |
Messages to others |
The interviews
Analysis
Results
Continuity of care
Having tests and being monitored
Being referred
Timing and frequency of appointments
Receiving information
Information about physical, emotional and psychological recovery
Information that helped make sense of their experience
Importance of expert reassurance
Giving feedback to ICU staff
No ICU follow-up
Discussion
Conclusions
Key messages
-
Patients value having ICU follow-up services but their healthcare needs are often not met because many hospitals are unable to provide the aftercare they require.
-
Patients view ICU follow-up services as an important contribution to their physical, emotional and psychological recovery in terms of continuity of care, receiving information, gaining expert reassurance and giving feedback to ICU health professionals about the care they received.
-
Continuity of care is important to patients in terms of having tests and being monitored, receiving referrals and ICU follow-up appointments soon after hospital discharge.
-
Patients without access to ICU follow-up services often feel abandoned or disappointed because they have no opportunity to get feedback on their progress, be referred quickly if they are having problems or find out the details of their illness and ICU stay.
-
Most patients are aware of the financial constraints on the health system and, although they value ICU follow-up care, they do not want it to continue indefinitely, with many of them declining appointment invitations when they themselves feel they no longer need them.