Should ICU clinicians follow patients after ICU discharge? No

Vijayaraghavan, Bharath Kumar Tirupakuzhi; Willaert, Xavier; Cuthbertson, Brian H.

doi:10.1007/s00134-018-5117-9

Cited by 27 publications

(18 citation statements)

References 11 publications

(13 reference statements)

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“…It has been proposed that future trials should focus on multi-disciplinary follow-up strategies, which might include physicians as well as other professions such as nurses, physiotherapists, occupational, speech and language therapists, psychologists, dieticians, social workers or clinical pharmacists. [56, 61, 62] Our study contributes to this goal by identifying specific medical disciplines that should be considered for multi-disciplinary post-ICU interventions.…”

Section: Discussionmentioning

confidence: 99%

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

et al. 2019

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BackgroundLittle is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample.MethodsCross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding.ResultsICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment.ConclusionsOur findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.

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Section: Discussionmentioning

confidence: 99%

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

et al. 2019

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“…[14][15][16][17] In addition, continuity of care at an ICU follow-up clinic may be difficult when the patient lives far from the ICU and needs frequent follow-up. [18][19][20] Even if intensive care doctors and nurses are familiar with complications after critical illness, their role in coordinating ICU follow-up is discussed controversially 17 21 : They seem not to be trained in outpatient care coordination and the clinical variety of possible post-ICU complications. 17 Additionally, they do not know their patients for long and therefore may lack insight into the patient's psychosocial background.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20] Even if intensive care doctors and nurses are familiar with complications after critical illness, their role in coordinating ICU follow-up is discussed controversially 17 21 : They seem not to be trained in outpatient care coordination and the clinical variety of possible post-ICU complications. 17 Additionally, they do not know their patients for long and therefore may lack insight into the patient's psychosocial background. 22 On the contrary, general practitioners (GPs) have a long-lasting relationship with their patients and provide care coordination as a core task, 23 which is highly appreciated by the patients.…”

Section: Introductionmentioning

confidence: 99%

General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

et al. 2021

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BackgroundPatients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied.ObjectivesThe aim of this study is to describe GPs’ views and experiences of caring for postsepsis patients and of participating a specific outreach training.DesignSemistructured qualitative interviews.Setting14 primary care practices in the metropolitan area of Berlin, Germany.Participants14 GPs who had participated in a structured sepsis aftercare programme in primary care.ResultsThemes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP’s experiences during their patient’s critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice.ConclusionsGPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit–GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare.Trial registration numberISRCTN61744782.

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“…Jones et al [10] showed in a randomised control trial that discussing diaries at one month can reduce the incidence of new PTSD following ICU stay. However, systematic reviews of the evidence base for these diaries show, in general, small cohorts with varying methodology and uncertain generalisation across all patient groups in the ICU [72][73][74]. One 'pragmatic' randomised control trial of nurse-led follow up showed no evidence of improved physical or psychological health at 12 months in the intervention group [75].…”

Section: Information Following the Eventmentioning

confidence: 99%

Distress in delirium: causes, assessment and management

2019

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Key Summary pointsAim Distress in delirium causes significant morbidity for patients and their relatives, but it remains under recognised. Findings This review discusses the current literature regarding distress in delirium: its aetiology, available assessment tools and potential avenues for management. Message The distress experienced in delirium has long-term psychological effects on patients and their carers, and requires greater understanding and acknowledgement in clinical practice. AbstractPurpose Delirium is a common clinical syndrome associated with increased physical and psychological morbidity, mortality, inpatient stay and healthcare costs. There is growing interest in understanding the delirium experience and its psychological impact, including distress, for patients and their relatives, carers and healthcare providers. Methods This narrative review focuses on distress in delirium (DID) with an emphasis on its effect on older patients. It draws on qualitative and quantitative research to describe patient and environmental risk factors and variations in DID across a number of clinical settings, including medical and surgical inpatient wards and end of life care. The article provides an overview of the available distress assessment tools, both for clinical and research practice, and outlines their use in the context of delirium. This review also outlines established and emerging management strategies, focusing primarily on prevention and limitation of distress in delirium. Results Both significant illness and delirium cause distress. Patients who recall the episode of delirium describe common experiential features of delirium and distress. Relatives who witness delirium also experience distress, at levels suggested to be greater than that experienced by patients themselves. DID results in long-term psychological sequelae that can last months and years. Preventative actions, such pre-episode educational information for patients and their families in those at risk may reduce distress and psychological morbidity. Conclusions Improving clinicians' understanding of the experience and long term psychological harm of delirium will enable the development of targeted support and information to patients at risk of delirium, and their families or carers.

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Should ICU clinicians follow patients after ICU discharge? No

Cited by 27 publications

References 11 publications

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

Distress in delirium: causes, assessment and management

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