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Follow-up after critical care

Introduction

Many patients experience physical and psychological morbidity following a stay in critical care [1]. The National institute of Clinical Excellence (NICE UK) recommends access to follow-up and rehabilitation services for this patient group [2]. We aim to present 1 year's experience following the establishment of a follow-up service at our university teaching hospital.

Methods

The multidisciplinary follow-up team consisted of a consultant in critical care, a senior nurse and a critical care physiotherapist. Patients completed a preclinic questionnaire followed by a semi-structured interview to identify potential issues. Twenty-four clinics took place over the 12-month period.

Results

A total of 221 patients were recruited. Of the patients studied 26% attended the clinic and completed the evaluation questionnaire, 30% did not engage follow up services. We identified recurrent themes in both physical and nonphysical problems. Example physical problems include limited physical activities in 77%, with 54% of patients studied finding difficulties with activities of daily living. Alteration in taste, smell, hearing and vision modalities was frequently described. In terms of psychological morbidity, anxiety and post-traumatic stress symptoms seem to predominate. Significant numbers of patients retain memory of their ITU stay, with one-third in the form of flashback memories. Only 5% of patients studied returned to work.

Conclusions

Our findings demonstrate that a wide variety of problems can be identified in an ICU follow-up clinic. The challenge now is to identify those groups of patients who will benefit most from follow-up, to develop effective rehabilitation programmes for these patients, and to find methods to increase patient participation.

References

  1. 1.

    Cuthbertson HG, et al: The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009, 339: b3723-10.1136/bmj.b3723.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  2. 2.

    CG83 Rehabilitation after Critical Illness. 2009, London: National Institute for Clinical Excellence

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Correspondence to M Slattery.

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Slattery, M., Temblett, P., Houghton, A. et al. Follow-up after critical care. Crit Care 15, P533 (2011). https://doi.org/10.1186/cc9953

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Keywords

  • Critical Care
  • Rehabilitation Service
  • Patient Participation
  • Psychological Morbidity
  • Vision Modality