Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Abstract

OBJECTIVES: The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. DESIGN: Cross-sectional survey. SETTING: Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated. PATIENTS: None. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%). CONCLUSIONS: Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

Social determinants of recovery

“…Although research on access to post-ICU care is desperately needed, the limited data available suggest wide international variation. Although most hospitals in the United Kingdom provide special postdischarge follow-up to survivors of critical illness [54], post-ICU recovery clinics in the United States are relatively scarce, concentrated in large academic hospitals, and dependent on discretionary funding [55], with evidence suggesting limited access to hospitals serving socioeconomically disadvantaged patients [56]. Beyond formal recovery clinics, community differences in follow-up services have been noted.…”

Hospital Discharge Summaries Are Insufficient Following ICU Stays: A Qualitative Study

“…Further, our institution has offered a post-ICU clinic since 2018; patients with the greatest need are often offered follow-up there. However, although post-ICU clinics play an important role in follow-up for many critical illness survivors, access to these clinics remains limited in the United States (32, 33), and processes to improve follow-up by other outpatient providers is vital to improve care broadly. Finally, we conducted these interviews as a qualitative “first step” to identify themes and key areas for improvement.…”

Interviews with primary care physicians identify unmet transition needs after ICU

“…Our findings reveal that primary care providers have concerns about post-critical illness transitions of care that could be partially remediated by actions of ICU clinicians even absent access to post-ICU clinics [ 1 , 2 ].…”

“…Access to specialized post-ICU care or follow-up remains limited in the USA [1][2][3]; most critical illness survivors will receive follow-up by a primary care provider (PCP) [4]. We hypothesized that experienced primary care physicians may be aware of gaps in ICU discharge processes, and therefore, we conducted interviews with such physicians to identify what they felt were common gaps that could be improved outside of specialized post-ICU settings.…”