Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center

J Crit Care. 2018 Aug;46:141-148. doi: 10.1016/j.jcrc.2018.02.011.

Abstract

Purpose: To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States.

Materials and methods: A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care.

Results: 218/307 referred patients (71%) survived to hospital discharge; 62 (28% of survivors) were seen in clinic. Median time from discharge to ICU-RC visit was 29days. At initial evaluation, 64% of patients had clinically meaningful cognitive impairment. Anxiety and depression were present in 37% and 27% of patients, respectively. One in three patients was unable to ambulate independently; median 6min walk distance was 56% predicted. Of 47 previously working patients, 7 (15%) had returned to work. Case management and referral services were provided 142 times. The median number of interventions per patient was 4.

Conclusions: An ICU-RC identified a high prevalence of cognitive impairment, anxiety, depression, physical debility, lifestyle changes, and medication-related problems warranting intervention. Whether an ICU-RC can improve ICU recovery in the US should be investigated in a systematic way.

Keywords: Cognitive impairment; Delirium; ICU follow-up clinic; Models of care; Post intensive care syndrome.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anxiety / complications
  • Cognition Disorders / complications
  • Cognitive Dysfunction
  • Continuity of Patient Care
  • Critical Care / methods
  • Critical Care / organization & administration*
  • Critical Illness / psychology*
  • Critical Illness / therapy*
  • Delirium / complications
  • Depression / complications
  • Disabled Persons
  • Feasibility Studies
  • Female
  • Hospitalization
  • Humans
  • Intensive Care Units / organization & administration*
  • Life Style
  • Male
  • Mass Screening
  • Middle Aged
  • Models, Organizational
  • Patient Care Team
  • Patient Discharge
  • Prospective Studies
  • Psychometrics
  • Survivors / psychology
  • Syndrome
  • United States