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Extended Critical Care Rehabilitation – Beyond the ICU

To fund a post-hospital rehabilitation programme for former ICU patients and their families, designed by ICU clinicians, patients and carers, to address physical, psychological and cognitive issues following critical illness.

Read comments 6 Project updates 1
  • Winning idea
  • 2020

Meet the team


  • Zoe van Willigen (Clinical Lead Physiotherapist GICU, UHS NHSFT)
  • Rachel Devlin (Divisional Therapy Manager, UHS NHSFT)
  • Fiona Hall (Senior ICU Nurse, UHS NHSFT)

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.

How you can contribute

  • Experiences from Q members who have had experience of promoting Trust improvement projects within STPs/ICSs/CCGs.
  • Identify opportunities for collaboration that we may not have spotted.
  • Data Experts who have knowledge of how we gain a better understanding on the healthcare needs of former critical care patients in the community.
  • Experts with a background in Critical Care, Physiotherapy and other specialities who have worked in patient rehabilitation, in order to learn from their experiences and
  • Supporters to spread the initiative

Plan timeline

1 Mar 2021 Engagement: Identify Stakeholders + First Stakeholder meeting/Workshop
15 Mar 2021 Educate: Begin staff preparation, competency/training needs
15 Mar 2021 Engagement: Engage with ICU staff and Gyms
15 Mar 2021 Engagement: Identify cohort of patients
22 Mar 2021 Engagement: Project Design (including Outcome Measures for collection)
5 Apr 2021 Execute: Individualise Patient centred rehab programme design
26 Apr 2021 Execute: First Gym Based Rehab Programme
10 May 2021 Execute: Second workshop incorporating feedback
24 May 2021 Execute: Re-evaluate programme
7 Jun 2021 Execute: Begin rolling programme of gym based rehab programmes
1 Nov 2021 Evaluate: Analysis of Data and patient feedback
21 Nov 2021 Evaluate: Stakeholder Meeting to share findings and discuss next steps
28 Nov 2021 Evaluate: Wider dissemination of findings: National Critical Care contacts/Q community

Project updates

  • 2 Nov 2021

    Mid-year update (Zoe vanWilligen, Rachel Devlin, Fi Hall):

    What a year it has been since we received our Q award! While much learning has been undertaken and progress made towards the execution phase of our project, it has been significantly delayed for a number of very valid reasons:

    1.      We are primarily a clinical team at University Hospital Southampton (UHS) with patient caseloads on ICU. As such the first few months of 2021 were all-consumed by the peak of the COVID pandemic.

    2.      Our original project was for a gym-based programme. Despite our best efforts in the design and in engaging with relevant stakeholders (patients, relatives, clinicians and the UHS Trust Quality Committee), it became clear that a face-to-face class approach was not feasible in the current climate.

    3.      We had to go back to the drawing board- we have since decided to run the programme virtually. We have made many links with teams nationally and internationally who deliver virtual rehabilitation classes for other health conditions. The learning from this has been hugely useful, but time consuming.

    While this complete design change initially seemed like a setback, we now feel that it is actually a very positive step. Our bid for funding was based on a previous face-to face pilot class, pre-pandemic. If we now deliver the same class virtually, we will be able to compare the two to see what works best for our population of patients. Additionally, the design fits the principles within the NHS Long Term Plan for digital transformation. We have consulted our patients and their families during our virtual ICU peer support program, and they anticipate potential benefits for virtual classes; no transport/ parking issues and the convenience of being in their own home while still benefitting from ‘group’ support.

    Our achievements to date:

    1.      Patients are being ‘screened’ for entry into the EMPOWER programme, through our virtual ICU follow up clinic.

    2.      We have made links with our trust’s digital team for the most appropriate online format and engaged with colleagues running virtual classes for other health conditions within UHS for their ‘top tips’.

    3.      Social media and national conferences have been utilised to network with peers who have also made the leap to the virtual world.

    4.      A suitable venue for online classes has been located, and safe numbers/ skill-mix of staff have been costed into the award fund.

    5.      We have visited and observed a local virtual pulmonary rehabilitation class, who were kind enough to share their practice and resources with us.

    6.      We are in regular contact with a successful international online health platform (BEAMfeelgood) who have also shared their wisdom around risk assessments and data collection/ evaluation for online exercise classes.

    7.      The patient support hub- a voluntary service at UHS- have been in touch and are happy to help us address any digital inequalities- delivering devices, explaining use of technology and even accompanying patients while they exercise if they live alone. They are also willing to help patients complete our pre and post programme assessments, plus anything else that is required to ensure inclusivity.

    8.      Some of the Q award fund has been used to purchase IPADs for patient use. We are also looking into the necessity for purchasing finger oxygen saturation probes too.

    9.      We are in contact with national ICU support websites ‘’ and ‘’. We already signpost patients towards these and hope to be able to collaborate more with them in the future.

    10.  The EMPOWER programme has been included within the UHS NEW (nutrition, exercise and wellbeing) centre initiative, to ensure a coordinated approach to rehabilitation service improvement and research within our trust.

    11.  The patient experience team at UHS have kindly redesigned our patient and relative questionnaires for before and after the EMPOWER programme.

    12.  We have engaged with the National Rehabilitation Collaborative (NRC) working group of the Intensive Care Society, who have asked us to keep them posted on our progress.

    Still to be completed prior to execution of the EMPOWER rehabilitation classes

    1.      We would like to incorporate some GP education into this fund- the practicalities of this are still being discussed.

    2.      The NRC have asked that we try to incorporate the screening tool ‘Post ICU presentation screen – PICUPS’ into our project. We are currently looking into the feasibility of this.

    3.      Once the design and start date are finalised, we need to timetable and cost our key MDT speakers into the education sessions.

    We have attended several of the Q evaluation and action learning sessions and have found these to be both inspiring and thought provoking. They have provided opportunity for shared learning which has stimulated problem solving within our own project. While it has been challenging designing a new service at the height of a pandemic, it has certainly been a unique and valuable learning opportunity for us all!


  1. Guest

    Lucy Pearson 1 year, 4 months ago

    Hi,  I work in a district hospital (East Surrey) as a physio on the outreach team. I review patients once they step down onto the ward from critical care and have started to get involved in their 3 month follow up. I would be interested to see how this project evolves and of there is anything I can do to contribute.

  2. As you know, I'm extremely supportive of this approach.  Especially now, in Covid-19 we are seeing post ICU rehab needs as a vital part of the recovery pathway - the quicker that we can rehabilitate people to their optimal normality, the quicker they can move on with their lives.

    Rehabilitation is woefully under commissioned, and any research to prove it's necessity and efficacy should be supported.

    Keep doing what you're doing team Critical Care Rehab!

  3. Guest

    Joy Halliday 1 year, 8 months ago

    Excellent work, also more than happy to share ideas as a member of Q and interest in ICU rehabilitation and follow up

    1. Thanks Joy - really appreciate it.

  4. Happy to contribute in as a many ways as possible. This is an area close to my own heart too as my background is in ICU and rehabilitation. You may have already done so, but if not then I have links into FICM, ICS and ACPRC/CSP.

    1. Thanks Gareth, will be great to get your views and thoughts on this!

      Will send you a direct message!

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