Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives

Abstract

Objective To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs. Methods Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine’s THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data. Results Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes. Conclusions The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area. Electronic supplementary material The online version of this article (10.1007/s00134-019-05647-5) contains supplementary material, which is available to authorized users.

Severe covid-19 pneumonia: pathogenesis and clinical management

“…Post-ICU recovery programs staffed by a team of providers (ie, pulmonologists, intensivists, pharmacists, advanced practice providers, nurses, physical and occupational therapists, respiratory therapists, social workers, case managers, and mental health providers) can diagnose and treat PICS impairments. [228][229][230] These clinics also facilitate access to necessary subspecialties (tables 3, 4). The comprehensive approach of post-ICU clinics mirror the magnitude that critical illness affects multiple domains of a patient's health.…”

Persistence of patient and family experiences of critical illness

“…Our findings suggest that many patients and families need help and support beyond traditional medical follow-up after an ICU admission, which is supported in work by others. 23 We found that participants may have difficulty adjusting to a 'new normal' and possibly lack resilience. Their ICU experience appears to shape the feelings they have about both the critical illness and their transition back to a 'normal life', consistent with other narrative studies in ICU populations.…”

Patients’ experiences of recovery: Beyond the intensive care unit and into the community

“…Similar to findings from this study, a study by Maley et al (2016) identified ongoing physical impairments, mental health issues, and difficulties in scheduling and coordinating follow-up appointments as major barriers faced by survivors. While other studies have addressed financial barriers to establishing post-ICU clinics (Haines et al, 2019), the current study identified personal financial barriers, including participants not being able to have the necessary follow-up procedures and care post-hospital discharge due to lack of insurance and money. Healthcare providers need to be aware of barriers that survivors experience after they are discharged to assist in overcoming these barriers.…”