Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia.

Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE

Publication: 2016- : New York : Elsevier
Original Publication: Chicago : American College of Chest Physicians

Critical Care*/organization & administration ; Intensive Care Units*/organization & administration; Humans ; Male ; Female ; Australia ; Qualitative Research ; Middle Aged ; Patient Discharge ; Caregivers/psychology ; Continuity of Patient Care/organization & administration ; Aged ; Adult ; Interviews as Topic ; Survivors/psychology ; Primary Health Care/organization & administration

Background: Critical care survivors experience multiple care transitions, with no formal follow-up care pathway.
Research Question: What are the potential solutions to improve the communication between treating teams and integration of care following an ICU admission, from the perspective of patients, their caregivers, intensivists, and general practitioners (GPs) from diverse socioeconomic areas?
Study Design and Methods: This study included a qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework analysis was used to analyze data and to identify solutions to improve the integration of care following hospital discharge. Patients were previously mechanically ventilated for > 24 h in the ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network.
Results: Forty-six interviews with clinicians, patients, and caregivers were completed (15 intensivists, eight GPs, 15 patients, and eight caregivers). Three higher level feedback loops were identified that comprised 10 themes. Feedback loop 1 was an ICU and primary care collaboration. It included the following: (1) developing collaborative relationships between the ICU and primary care; (2) providing interprofessional education and resources to support primary care; and (3) improving role clarity for patient follow-up care. Feedback loop 2 was developing mechanisms for improved communication across the care continuum. It included: (4) timely, concise information-sharing with primary care on post-ICU recovery; (5) survivorship-focused information-sharing across the continuum of care; (6) empowering patients and caregivers in self-management; and (7) creation of a care coordinator role for survivors. Feedback loop 3 was learning from post-ICU outcomes to improve future care. It included: (8) developing comprehensive post-ICU care pathways; (9) enhancing support for patients following a hospital stay; and (10) integration of post-ICU outcomes within the ICU to improve clinician morale and understanding.
Interpretation: Practical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.
Competing Interests: Financial/Nonfinancial Disclosures None declared.
(Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Keywords: aftercare; critical care; general practice; primary care; qualitative; recovery

Date Created: 20240221 Date Completed: 20240710 Latest Revision: 20240710

20240711

10.1016/j.chest.2024.02.019

38382876