ABSTRACT
BackgroundThere is increasing recognition that palliative care when provided appropriately to critically ill patients with life limiting illness can not only offer physical, psychosocial and spiritual care to patients but also helps improve family and staff satisfaction.1 Given this, a multi-disciplinary group within the critical care unit of the Royal Alexandra Hospital was established to improve the delivery of palliative care. A staff survey highlighted the desire from staff to improve bereavement support for both families and staff. In light of this, the decision was made to host a remembrance service in memory of patients who had passed away in the unit during Covid-19 pandemic.MethodsFunding was secured from the charity To Absent Friends. The critical care database, Ward Watcher, was utilised to collate the details of patients who had passed away in the unit from March 2020 until August 2021. The number of patients identified was 237. The families of each patient were invited. A non-denominational remembrance service consisting of readings, live music and acts of remembrance was held in November 2022.Data13 staff and 40 families attended. 69% of staff who attended completed a feedback survey. 89% reported that the service brought them benefit and 100% reported that they would want the service to be held again. Written feedback from families included: ‘The Service on Saturday became our ‘closure' time and helped me get a new perspective on the last two years'ConclusionsAlthough the feedback received was limited, the data suggests that a remembrance service can be of benefit to both families and staff, particularly in the context of a pandemic when visiting was curtailed. This collaborative project has also demonstrated the need for further cross specialty working in order to ensure the delivery of palliative care within a critical care unit.ReferenceIto K, George N, Wilson J, et al. Primary palliative care recommendations for critical care clinicians. J Intensive Care 2022;10:20. https://doi.org/10.1186/s40560-022-00612-9
ABSTRACT
RATIONALE: At present, clinicians aiming to support patients through the challenges after critical care have limited evidence to base interventions. OBJECTIVES: Evaluate a multicentre integrated health and social care intervention for critical care survivors. A process evaluation assessed factors influencing the programme implementation. METHODS: This study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme. We compared patients who attended this programme with a usual care cohort from the same time period across nine hospital sites in Scotland. The primary outcome was health-related quality of life (HRQoL) measured via the EuroQol 5-dimension 5-level instrument, at 12 months post hospital discharge. Secondary outcome measures included self-efficacy, depression, anxiety and pain. RESULTS: 137 patients who received the InS:PIRE intervention completed outcome measures at 12 months. In the usual care cohort, 115 patients completed the measures. The two cohorts had similar baseline demographics. After adjustment, there was a significant absolute increase in HRQoL in the intervention cohort in relation to the usual care cohort (0.12, 95% CI 0.04 to 0.20, p=0.01). Patients in the InS:PIRE cohort also reported self-efficacy scores that were 7.7% higher (2.32 points higher, 95% CI 0.32 to 4.31, p=0.02), fewer symptoms of depression (OR 0.38, 95% CI 0.19 to 0.76, p=0.01) and similar symptoms of anxiety (OR 0.58, 95% CI 0.30 to 1.13, p=0.11). There was no significant difference in overall pain experience. Key facilitators for implementation were: integration with inpatient care, organisational engagement, flexibility to service inclusion; key barriers were: funding, staff availability and venue availability. CONCLUSIONS: This multicentre evaluation of a health and social care programme designed for survivors of critical illness appears to show benefit at 12 months following hospital discharge.