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

• Type of Material: Article
• Authors: Joanne McPeake, University of Glasgow; Leanne M. Boehm, Vanderbilt University; Elizabeth Hibbert, Western Health Melbourne; Rita N. Bakhru, Wake Forest University; Anthony J. Bastin, St Bartholomew's Hospital; Brad W. Butcher, University of Pittsburgh; Tammy L. Eaton, University of Pittsburgh; Wendy Harris, University College London; Aluko A. Hope, Yeshiva University; James Jackson, Vanderbilt University; Annie Johnson, Mayo Clinic; Janet A. Kloos, University Hospitals Cleveland Medical Center; Karen A. Korzick, Geisinger Medical Center; Pamela MacTavish, Glasgow Royal Infirmary; Joel Meyer, Guy's & St Thomas' NHS Foundation Trust; Ashley Montgomery-Yates, University of Kentucky; Tara Quasim, University of Glasgow; Andrew Slack, Guy's & St Thomas' NHS Foundation Trust; Dorothy Wade, University College London; Mary Still, Emory University; Giora Netzer, University of Maryland; Ramona O. Hopkins, Intermountain Medical Center; Mark E. Mikkelsen, University of Pennsylvania; Theodore J. Iwashyna, University of Michigan; Kimberley J. Haines, Sunshine Hospital; Carla M. Sevin, Vanderbilt University
• Language: English
• Date: 2020-04
• Publisher: Society of Critical Care Medicine
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000088
• Title of Journal or Parent Work: Crit Care Explor
• Volume: 2
• Issue: 4
• Start Page: e0088
• End Page: e0088
• Grant/Funding Information: Supported, in part, by grant from the Society of Critical Care Medicine (SCCM). The scientific questions, analytic framework, data collection, and analysis were undertaken independently of the funder. The SCCM Council reviewed the article and offered input prior to finalization.
• Keywords: post-intensive care syndrome; peer support; intensive care unit follow-up clinics
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Immunology; Biology, Physiology; Health Sciences, Nursing

Abstract

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.