ABSTRACT
Introduction: The EMPOWER (Early Mobilisation PrOject With Extended Rehabilitation) classes at University Hospital Southampton (UHS) originated in direct response to patient voice. During an interview study exploring patient and family experience of rehabilitation on ICU,1 the wife of an ICU patient stated: There was no point in spending all of that money on keeping him alive if you're not gonna get him better. He's alive, but he's not functioning Objective: To explore if post ICU outpatient rehabilitation classes can be effective in addressing symptoms of PICS, for patients previously admitted to critical care at UHS. Methods: Funding was obtained to trial a pilot project of 8 classes over 8 weeks, starting in September 2019. Due to time constraints, original inclusion criteria were abolished and instead a convenience sample of 8 patients were selected, along with a relative if desired. Design was a 3-hour class, once a week, in a small gym venue within an acute hospital setting. Patient transport costs were covered, as had previously been highlighted as an incentive to participation in other studies.2 During the first hour of the class, former ICU patients completed an exercise circuit, while their relatives attended a separate peer support session, facilitated by experienced ICU volunteers. The second hour was an education session, provided by an ICU healthcare professional (e.g., dietitian, occupational therapist). The final hour was for peer support and goal setting. One participant withdrew from the pilot following the first week and was signposted elsewhere. The demographic details for the remaining 7 participants represent are included in Table 1. In addition, four female relatives also participated and evaluated the pilot. Results: Outcome measures reflected the physical, cognitive and psychological domains of PICS. These were collected from assessments at week 1 and week 8, and the mean results are presented in Table 2. In addition, qualitative data was collected before and after the 8-week course. Examples of quotes from participants at the start of the pilot include: I have reduced my working hours to spend more time at home with her I feel dreadful. I'm not getting better. I lose words midsentence, and have memory problems Feedback following the pilot was very positive. One participant reported: It's been a safe space for me, as a 'carer', to express my fears and concerns and to get help, advice and support from people who really understand the issues of post-ICU recovery. Our GP practice really doesn't seem to provide any after-care/ follow up care for this. Conclusion: In this small pilot project of post ICU outpatient rehabilitation classes, all outcome measures improved despite participant heterogeneity. Patient/ relative satisfaction for the classes was high. Wehave since managed to secure £30k through the Q Exchange to continue the work of EMPOWER following the COVID-19 pandemic.
ABSTRACT
Objective The Covid-19 pandemic has presented challenges to maternity services, but has provided the opportunity for adaptations;here we look at monitoring blood pressure in at risk women. Our aim was to compare clinical outcomes between women who used home blood pressure monitoring, and a retrospective group of those who did not, based on parameters set out in existing literature. Women who met the criteria set out in RCOG guidelines and were deemed suitable were loaned a home blood pressure monitor (HBPM) and self tested their urine for protein. Design Retrospective data collection was carried out on two separate cohorts;1 cohort from April - June 2020 when HBPM was introduced, and one from the same time frame in 2019, prior to the introduction of HBPM. 40 patients were identified in each cohort. Method A proforma was drawn up assessing a number of different parameters regarding delivery outcomes. The patients to be included were identified using a record book of HBPM users, and by generating a NIMATs search using relevant keywords. ECR was used to find relevant data once the cohorts had been identified. Results There was a clear difference in induction of labour (IOL) rates between the two cohorts - 70% versus 50%;showing a reduction in IOL if the HBPM service was used. Of those induced;28 were induced for PIH in the non HBPM group, which is the sole indication in this group, compared to 11 in the HBPM group, (over half the total number of inductions within this cohort). There is a clear difference in the diagnosis of Pre eclampsia (PET) - 35% compared to 13% - a possible indication that HBPM can detect PET earlier in pregnancy. We did not see a significant difference in antenatal admissions between cohorts as per existing literature;however, study design could be adapted to further assess this. In keeping with published studies, we did not see significant differences between cohorts in other clinical outcomes. Conclusions This audit supports the literature that demonstrates HBPM reduces the incidence of IOL and diagnosis of pre eclampsia. There was a halving of number of IOL for hypertensive disease. The next phase of this project is introduction of HBPM postnatally. HBPM in pregnancy is a safe and effective choice for women. The reduction in unnecessary hospital and primary care attendances have clear benefits for women in reducing time and travel expenditure.