Critical Care Clinics - do you have one?

Todd Fraser on 23-02-2013

The long term outcomes of ICU patients has gained increasing interest over the last decade. As mortality in ICU falls worldwide, the impact of therapeutic interventions has been more difficult to demonstrate, and interest has turned to markers of morbidity and quality of life.

In 2011 the Society of Critical Care Medicine convened an expert panel to look at research and guidelines to support recover from what they termed "Post Intensive Care Syndrome". Conditions such as long term motor weakness, cognitive disturbance and post traumatic stress disorder have profound consequences for patients, and in some cases their families.

This has led to the development in some centres of a post-ICU follow up clinic. One of the earliest centres to do this was Whiston in the UK, headed by Christina Jones. In an upcoming podcast in Crit-IQ, she describes the impact of these clinics, not just on individual patients, but also on the practices of their ICU, as they realised some of the impact their care was having. Its a great interview for all those interested in the outcomes of their patients.

A recent review found only 30% of ICUs in the UK have follow up clinics. Given the prevalence of complications in many patient groups, this is hard to fathom. In Australasia, the concept has found even less favour.

Does your unit have one? What has your experience been with it if you have?

7 Comments

Got something to say?

Log in to your account

Forgotten your password?

Abbas from UAE wrote 03-03-2013 01:57:51 am
Well, although it is a new concept but ,it is very interesting topic. I do have a very good experince with my post ICU clinc when I was working in Iran as a head of ICU in trauma center. actually it was the first time that an intentensivist with anesthesia background asking to follow his patients after discharging them from hospital. I was very fortune and surprised that the hospital directors accepted my suggestion and helped me to do so. my concept was that , many patients after discharging from ICU and may leave hospitial with different kind of medical requirement and in different health status and in this point , the Intensivist is the person who is already familiar with patient condition and will be able to manage the patient properly or reffer him/her to the other consultants otherwise, patients may go around to find his surgeon, his internist, his pumonologist, .....
I with every hospitls have a post ICU clinics to serve better their patients.
Dr. Abbas Khosravi

Todd Fraser from Australia wrote 03-04-2013 10:19:53 am
Fantastic post Abbas. It seems we have almost none of these clinics set up in Australia. The UK has about 30% of ICUs with clinics, not sure about other parts of the world.

I agree, it seems very important that we be involved, both for direct contribution to patient care, and also to receive some feedback on our performance. What are the changes that you've made to your practice based on the outcomes in the clinic?

Kristine Estensen from AUSTRALIA wrote 03-05-2013 11:09:50 am
I think the concept is a very good one. I would really like to participate in an ICU outpatient clinic. I see it happening "informally" when sometimes patients and their families want to see you after they leave hospital. I have found the patients who have had long stays and stormy courses, sometimes wish to "fill in the blanks" and actually talk to you about what happened to them.

I can think of quite a few patients who have returned to the ICU where coming back and talking about their stay seemed to "close the circle" for them. I should imagine that parts of ICU treatment are very frightening and maybe this gives patients a sense of getting control bcak over their illness or circumstances. At the moment these meetings and discussions are mediated informally when patients and relatives request. Maybe providing this as an option post ICU discharge should be looked at. I would imagine the cost would be an issue in the current climate.....but if there is clear benefit (as Abbas is highlighting above). We also I feel need to consider the psychological impact of ICU on our patients a little more. Physically recovering from an illness is only part of it and I often worry about if our ICU patients have ongoing psychological problems. I know that PTSD type symptoms and depression are often mentioned as is chronic pain. Great blog topic Todd. Kristine

Lorette from Netherlands wrote 03-13-2013 08:50:47 am
I'm Lorette and i work as an ic nurse in Haarlem, netherlands . I work together with 3 other intensive cares and a high scool to improve family centered care in the icu .We made tools to structure and professionalise this care and to improve our care working together with fields experts . We made a CQ index to measure family satisfaction during their stay in icu. From this project we learned a lot from post intensive care clinics , what the impact is on ex patients and their relatives. We have more and more of these clinics and work on a big network that will cover the whole of our country to improve the post ic care. Also their intensive cares that organise Support groups to support patients and their relatives through the long road to recovery from criticall illness.
Visit the blog.han.nl/acute-intensive-zorg / and the linkedin group " family centered intensive care "

Angus from Australia wrote 03-27-2013 02:19:32 pm
Sounds like it's time to formally find out out what the current state of play is in Australia and New Zealand. I have just started a literature search regarding ICU follow-up clinics in Australia and precious little is turning up. Do we have an "expert" in the area? A champion if you will? If so, I would love to discuss this issue further.

Todd Fraser from Australia wrote 03-27-2013 08:17:57 pm
Christina Jones in Whiston in the UK is the world leader on the subject. I've got her details if you contact me directly. I've done a podcast on it with her and will release this soon

Sue Berney is a physio from the Austin who is into rehabilitation in the ICU and is an invitee on the SCCM recovery-from-ICU committee. If there is anyone who is working in the area of post-ICU recovery clinics, she'd know. I've heard the Austin might have one?

Todd Fraser from Australia wrote 07-08-2013 07:03:28 pm
Check out this week's podcast with Dr Christina Jones. Christina has been running outpatient clinics for ICU survivors for 25 years, and in that time has developed a number of tools used to improve patient outcomes.

Check it out on the podcasts - www.crit-iq.com/podcast