Developing a Clinical Health Psychology pathway for ICU trauma patients
- Winning idea
What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?
Best practice guidelines suggest that those experiencing psychological problems during and following admission to Intensive Care Unit (ICU) require assessment and appropriate intervention from qualified psychologists, these only account for <1% of referrals to the Clinical Health Psychology Services (CHPS) despite a systemic review (2019) suggests that 1 in 5 critical care survivors experience Post Traumatic Stress Disorder.
During COVID-19, regional and local collaboration led to new guidelines for Health and Social Care Trusts to provide psychological assessment and support to adults admitted to ICU with COVID-19 regarding identification and response to trauma. CHPS now attends monthly ICU follow-up clinics with ICU colleagues to identify and respond to trauma and psychological adjustment during the recovery journey. Clinical Psychology assessments are now offered to those attending ICU post-COVID 19 as per agreed regional guidelines but this does not allow for follow up for other adults admitted to ICU who are also likely to experience trauma.
What does your project aim to achieve?
This project aims to reduce health inequalities by ensuring all appropriate ICU service users will have access to Clinical Health Psychology services (CHPS) at point of referral, by developing joint review sessions with ICU.
Additional resources will also be developed, including
- A service user forum to provide resources and share experiences with one another
- Training resources for staff within both CHPS and ICU (to be identified)
We aim to marry current best practice guidance with existing literature, and input from experienced staff & post-ICU service users to develop bespoke guidance within the NHSCT. This will include efficient and effective pathways and processes to support. Alongside this will be the further development and use of bedside technology to assist early identification of trauma. This project and collaboration between ICU and CHPS will potentially benefit all those admitted to ICU through embedded processes of prevention, identification and early intervention during admission to ICU.
How will the project be delivered?
By establishing a Service User Reference Group and reviewing research literature, this will inform the scoping exercise to identify key changes required to meet trauma informed standards of care. The aim is to identify and, where necessary, establish standards and to measure service delivery against these.
The project will be carried out using a combination of Model for Improvement methodologies and PRINCE2 project management. Team members have and will be identified from existing ICU, Clinical Health Psychology, Innovation and Quality Improvement, and Service User representation.
Impact will be measured by focusing on
- reduction of waiting times,
- number of service users assessed by the Clinical Health Psychology Service,
- staff and service user feedback.
These measures will be monitored closely and inform change ideas throughout the course of the project. Measures will also consider the implications on cost avoidance by introducing this project.
Clinical risk will be managed through current service provision.
How is your project going to share learning?
The Project will be shared with Q members either through site visits or online.
This will also be shared regionally on the HSCQI Website and through our local Innovation and Quality Improvement Hub and Annual event.
It will also be shared wider with Healthcare Improvement Alliance Europe, as well as through Regional and National Critical Care Networks.
It is anticipated that this will also be published, based on findings.
How you can contribute
- Shared learning from similar projects. If this has been developed elsewhere it would be very helpful to understand what happened, how and the impact it had.
- Critical friends welcome - any suggestions on how to refine this project would be greatly appreciated.
|26 Oct 2020||Project Board is formed|
|30 Nov 2020||Review of literature commences|
|1 Mar 2021||Project Team identified and formed|
|1 Mar 2021||Service Users identified and contacted|
|15 Mar 2021||Feedback to group regarding resources required|
|15 Mar 2021||First collaborative meeting take place|
|29 Mar 2021||Development of resources commences|
|10 May 2021||Resources trialled|
|8 Nov 2021||Review of trial|
|22 Nov 2021||Approval of resources - begin wider rollout|
4 Oct 2021
Our Learning so far…
- Implementing a new service development project during the pandemic has been challenging, primarily due to competing demands, including additional workload, which has made it more difficult to co-ordinate diaries for project team meetings.
- Although practically challenging, this collaborative project has created an opportunity for two services, known to each other but without any established co-working, to take patient care forward together
- Be realistic about timelines and goals
- Good ideas don’t need to be complicated
- Developing a common language and a shared vision is important to as early as possible
- Virtual service delivery does not work well with psychometric outcome measurement – the need to develop virtual access to support completion of pre and post outcome measurement
What we have achieved
- We have conducted an initial literature review to identify best practice in relation to identifying and responding to psychological trauma in critical care
- We have established a project team and agreed a project plan with clear goals
- We have established Clinical Health Psychology input to the virtual multi-disciplinary post-ICU clinics
- We have designed and conducted a Service User survey about the virtual multi-disciplinary post-ICU clinics, to inform our practice and development
- We have identified and implemented clinical care recording within Clinical Health Psychology to capture activity data relating to service provision
We have contributed to Northern Ireland regional task and finish group to develop
- We have contributed to the development of Northern Ireland regional guidelines and service user information
- We have incorporated these regional guidelines and service user information into service provision
- The Clinical Health Psychology Service has continued to provide a point of contact for staff working in critical care for staff support during the pandemic
- We have identified service users who may potentially form a service user forum to enable a co-design approach to service development
What is working well
- A willingness within the project team to work collaboratively is one of the key elements of this project
- The level of collaboration and openness to learn within the project team has created a safe and supportive environment for shared learning and the development of positive working relationships
- The pandemic has highlighted the psychological needs of those admitted to critical care alongside the need for staff support for those working in critical care
- The virtual format has enabled access to professional colleagues from across the UK and further afield to support the knowledge of the project team.
Recruitment to project roles to build capacity within the project team to meet the project goals where possible
A call out to the Q community:
To encourage Q members with experience of developing in-reach service provision to share their top tips
To encourage Q members with experience of working with Service User forums to co-design services to share their top tips
- Development of a Service User support group
Working with Business Innovation to secure solutions for virtual access to psychometric outcome measures