Extended Critical Care Rehabilitation – Beyond the ICU

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

When a patient leaves ICU within most hospitals, there is only a verbal or written handover to ward staff, and a one-off ICU follow up appointment made post hospital discharge.

During COVID, Southampton utilised additional staff redeployed to ICU to enhance the rehabilitation pathway for patients after their ICU stay. This included new multidisciplinary (MDT) collaborations and input into patients’ follow-up after hospital discharge (2-week follow up phone calls and 3-month virtual follow-up clinic). However, it also highlighted specific issues that arise at certain time points after hospital discharge (fatigue, breathlessness, anxiety, depression).

Without ICU clinicians addressing these issues in the post hospital phase, there is a concern that patients will struggle in the community, which may impact upon the wider health economy. Patient feedback included gratitude for trusted, familiar faces for reassurance, and being able to make sense of hallucinations/amnesia with staff who knew their experiences.

What does your project aim to achieve?

The project will address many of the complex issues that arise as a consequence of critical illness, known collectively as Post Intensive Care Syndrome (PICS). The ICU admission itself is focussed on survival, but a relative of one Southampton patient has said:

“what was the point in spending all that money on saving his life, when he is now home – alive, but not living?”

PICS has been extensively investigated and problems can persist for months or even years after ICU. Critical points where patients are known to struggle are after discharge to the ward and again after discharge home.

Building and learning from a previous small pilot, this project will focus on health after discharge home. We will deliver a gym-based exercise, peer support and education programme. Both physical and non-physical outcomes will be measured to monitor the improvement in this cohort of patients.

How will the project be delivered?

Focus groups with clinicians and patient and public involvement groups (PPI) for design and relevance, learning from post covid experiences, previous experiences of other similar classes and feedback from Q community members.

We aim to deliver a gym-based rehabilitation program following hospital discharge for former ICU patients. The class will be divided into three components; an exercise circuit, educational session delivered by an ICU MDT member and peer support. Patients will be encouraged to set individual weekly goals which may be physical (e.g. walking further) or psychological (e.g. completing a tricky jigsaw).

Relatives of patients will be encouraged to attend the weekly class as they too can suffer psychological problems when a loved one is admitted to ICU. Relatives will be invited to attend an additional family support session, while the patients are completing the exercise circuit. They will then join in with the education and general peer support sessions.

How is your project going to share learning?

Learning following the evaluation phase of the project will be shared widely through Network specialist rehab meetings, clinical forums and conferences (The Network has representation from 20 Critical Care Units within Thames Valley & Wessex). We will also utilise national critical care contacts to share learning, as well as updating on progress widely through social media.

The goal would be for the information and data to be used across other organisation to help them evaluate and justify if a similar service could be replicated in their organisations.