1
|
Leggett N, Emery K, Rollinson TC, Deane AM, French C, Manski-Nankervis JA, Eastwood G, Miles B, Witherspoon S, Stewart J, Merolli M, Ali Abdelhamid Y, Haines KJ. Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia. Chest 2024; 166:95-106. [PMID: 38382876 DOI: 10.1016/j.chest.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Critical care survivors experience multiple care transitions, with no formal follow-up care pathway. RESEARCH QUESTION What are the potential solutions to improve the communication between treating teams and integration of care following an ICU admission, from the perspective of patients, their caregivers, intensivists, and general practitioners (GPs) from diverse socioeconomic areas? STUDY DESIGN AND METHODS This study included a qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework analysis was used to analyze data and to identify solutions to improve the integration of care following hospital discharge. Patients were previously mechanically ventilated for > 24 h in the ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network. RESULTS Forty-six interviews with clinicians, patients, and caregivers were completed (15 intensivists, eight GPs, 15 patients, and eight caregivers). Three higher level feedback loops were identified that comprised 10 themes. Feedback loop 1 was an ICU and primary care collaboration. It included the following: (1) developing collaborative relationships between the ICU and primary care; (2) providing interprofessional education and resources to support primary care; and (3) improving role clarity for patient follow-up care. Feedback loop 2 was developing mechanisms for improved communication across the care continuum. It included: (4) timely, concise information-sharing with primary care on post-ICU recovery; (5) survivorship-focused information-sharing across the continuum of care; (6) empowering patients and caregivers in self-management; and (7) creation of a care coordinator role for survivors. Feedback loop 3 was learning from post-ICU outcomes to improve future care. It included: (8) developing comprehensive post-ICU care pathways; (9) enhancing support for patients following a hospital stay; and (10) integration of post-ICU outcomes within the ICU to improve clinician morale and understanding. INTERPRETATION Practical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.
Collapse
Affiliation(s)
- Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia.
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Thomas C Rollinson
- Department of Physiotherapy, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Glenn Eastwood
- Department of Critical Care, Austin Health, Melbourne, VIC, Australia
| | - Briannah Miles
- Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia
| | | | - Jonathan Stewart
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Mark Merolli
- Centre for Digital Transformation of Health, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, the University of Melbourne, Melbourne, VIC, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Haines KJ, Ferrante LE. Prediction of Post-ICU Impairments-Is It Possible? Crit Care Med 2024; 52:337-340. [PMID: 38240513 DOI: 10.1097/ccm.0000000000006082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, & Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| |
Collapse
|
3
|
Haylett R, Grant J, Williams MA, Gustafson O. Does the level of mobility on ICU discharge impact post-ICU outcomes? A retrospective analysis. Disabil Rehabil 2024:1-6. [PMID: 38293804 DOI: 10.1080/09638288.2024.2310186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Mobilisation is a common intervention in Intensive Care (ICU). However, few studies have explored the relationship between mobility levels and outcomes. This study assessed the association of the level of mobility on ICU discharge with discharge destination from the hospital and hospital length of stay. MATERIALS AND METHODS A retrospective analysis of data from 522 patients admitted to a single UK general ICU who were ventilated for ≥5 days was performed. The level of mobility was assessed using the Manchester Mobility Score (MMS). Multivariable regression analysed demographic and clinical variables for the independence of association with discharge destination and hospital length of stay. RESULTS MMS ≥5 on ICU discharge was independently associated with discharge destination and hospital LOS (p < 0.001). Patients achieving MMS ≥5 on ICU discharge were more likely to be discharged home (OR 3.86 95% CI 2.1 to 6.9, p < 0.001), and had an 11.8 day shorter hospital LOS (95% CI -17.6 to -6.1, p < 0.001). CONCLUSIONS The ability to step transfer to a chair (MMS ≥5) before ICU discharge was independently associated with discharge to usual residence and hospital LOS, irrespective of preadmission morbidity. Increasing the level of patient mobility at ICU discharge should be a key focus of rehabilitation interventions.
Collapse
Affiliation(s)
- Rebekah Haylett
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Grant
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark A Williams
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| |
Collapse
|
4
|
Stewart J, Bradley J, Smith S, McPeake J, Walsh T, Haines K, Leggett N, Hart N, McAuley D. Do critical illness survivors with multimorbidity need a different model of care? Crit Care 2023; 27:485. [PMID: 38066562 PMCID: PMC10709866 DOI: 10.1186/s13054-023-04770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.
Collapse
Affiliation(s)
- Jonathan Stewart
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Judy Bradley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timothy Walsh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nina Leggett
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|