Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center

Abstract

Objectives: Post-ICU clinics may facilitate the care of survivors of critical illness, but there is a paucity of data describing post-ICU clinic implementation. We sought to describe implementation of our ICU recovery clinic, including an assessment of barriers and facilitators to clinic attendance. Design: Adults admitted to the medical ICU of a large tertiary care academic hospital with shock and/or respiratory failure requiring mechanical ventilation were screened for participation in a newly formed ICU recovery clinic. Participant selection and attendance rates were tracked. Reasons for nonattendance were assessed by phone call in a subset of patients. Setting: A newly formed ICU recovery clinic of a large tertiary care academic hospital. Patients: All patients admitted to the medical ICU were screened. Interventions: ICU recovery clinic appointments were scheduled for all eligible patients. A subset of nonattenders were called to assess reasons for nonattendance. Measurements and Main Results: Over 2 years, we admitted 5,510 patients to our medical ICU. Three hundred sixty-two were screened into the recovery clinic. One-hundred sixty-six were not scheduled for clinic; major reasons included discharge to hospice/death in the hospital (n = 55) and discharge to a facility (n = 50). One-hundred ninety-six patients were scheduled for a visit and of those, 101 (52%) arrived to clinic. Reasons for nonattendance in a surveyed subset of nonattenders included patient’s lack of awareness of the appointment (50%, n = 9/18), financial concerns (17%, n = 3/18), and transportation difficulty (17%, n = 3/18). Conclusions: ICU recovery clinics may address the needs of survivors of critical illness. Barriers to clinic attendance include high mortality rates, high rates of clinic appointment cancelations and nonattendance, and discharge to locations such as skilled nursing facilities or long-term acute care hospitals. Improved communication to patients about the role of the clinic may facilitate attendance and minimize canceled appointments.

Recovery from COVID-19 and acute respiratory distress syndrome: the potential role of an intensive care unit recovery clinic: a case report

“…Our ICU recovery clinic consists of a transdisciplinary team that includes a physician, an advanced practice registered nurse (APRN), a pharmacist, a physical therapist, and a social worker focused on improving quality of life after critical illness, organizing subspecialty follow-up care, and promoting rehabilitation. The primary objectives of ICU follow-up or recovery clinics are to address and treat post–intensive care syndrome (PICS) and help patients reintegrate into their societal roles following an admission to the ICU [ 4 – 7 ]. Post-ICU follow-up clinics also address traumatic emotional experiences of family members and engage all parties to optimize outcomes [ 8 – 11 ].…”

Factors Associated With Home Visits in a 5-Year Study of Acute Respiratory Distress Syndrome Survivors

“…Some published studies of this type of clinic have shown attendance rates below 50%. [45][46][47] This study has potential limitations. First, participants' prehospitalization health, physical function, and quality of life status were obtained from retrospective interviews, which may have introduced recall bias.…”

Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice

“…Several countries have invested significant efforts into ICU follow-up clinics to help support recovery following critical illness in adults (132)(133)(134)(135). ICU follow-up clinics usually require the patient to attend the hospital to see a combination of interdisciplinary professionals, who assess progress in all PICS domains, provide medication therapy review, reconciliation and counselling, and coordinate care and communication with primary care providers and other specialists as needed.…”