Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?

Abstract

Objectives: To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized. Design: International, qualitative study. Setting: Fourteen hospitals in the United States, United Kingdom, and Australia. Patients: We conducted 66 semi-structured interviews with a diverse group of patients, 52 of whom had used an ICU recovery program and 14 whom had not. Interventions: None. Measurements and Main Results: Using content analysis, prevalent themes were documented to understand what improved their outcomes. Contrasting quotes from patients who had not received certain aspects of care were used to identify perceived differential effectiveness. Successful ICU recovery programs had five key components: 1) Continuity of care; 2) Improving symptom status; 3) Normalization and expectation management; 4) Internal and external validation of progress; and 5) Reducing feelings of guilt and helplessness. The delivery of care which achieved these goals was facilitated by early involvement (even before hospital discharge), direct involvement of ICU staff, and a focus on integration across traditional disease, symptom, and social welfare needs. Conclusions: In this multicenter study, conducted across three continents, patients identified specific and reproducible modes of benefit derived from ICU recovery programs, which could be the target of future intervention refinement.

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

“…Peer support benefits patients, relatives, and staff during survivorship. 15 38 39 Six models have been described 17 ; our data indicate a predominance of community-based peer support with no evidence for online delivery, although this may have evolved in the interim due to pandemic restrictions to physical in-person meeting. Barriers (eg, non-attendance, access to skilled facilitators and bureaucratic limitations) and enablers (eg, motivated interprofessional clinicians, patient and family volunteers, links to ICU follow-up clinics) to peer support services have been previously explored through focus group inquiry with clinicians.…”

“…Evidence-gaps exist around the optimum version of either modality and the service-user voice is often missing in shaping research. 15 Reliance on internal funding sources to deliver services results in the disparity in workforce composition seen in our findings. In the future, standardising data collection across services may serve to build evidence around the impact on patient outcomes.…”

Continuing Cardiopulmonary Symptoms, Disability, and Financial Toxicity 1 Month After Hospitalization for Third‐Wave COVID‐19: Early Results From a US Nationwide Cohort

“…40 These data may, indeed, look worse at later follow-up given the delay in hospital billing and new expenses in the wake of illness and hospitalization. 28,36,41 It is important that the healthcare system and policymakers consider early investments in post-hospital rehabilitation and adaptive services, to allow workers to return to the workforce as soon as possible, and prepare for an increased need for financial support for recovering COVID patients. 42 Importantly, these data cannot distinguish between the impact of SARS-CoV-2 infection itself from the treatment received for COVID-19 or other non-COVID-19-specific aspects of hospital care.…”

Quotations in Qualitative Studies: Reflections on Constituents, Custom, and Purpose

“…For example, while suggesting that their study was situated within the socialist-constructivist paradigm, Heery et al (2019) propose that verbatim quotes enhanced the confirmability of the findings, whereas Roman et al (2020) indicate that, in their phenomenological study, "each of the main themes was defined and illustrated with representative quotes from the participants" (p. 405). McPeake et al (2020), on the other hand, conducted a qualitative inquiry analyzed with thematic content analysis and inserted "extracted quotations to support the thematic analysis" (p. 3). While we recognize that, although the above, random examples, and many others, did not equally propose a rationale for presenting the quotations, it may well be a result of a rule of thumb or guideline adherence, for example, to COREQ.…”