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Evolution in Care Delivery within Critical Illness Recovery Programs during the COVID-19 Pandemic: A Qualitative Study.
Eaton, Tammy L; Sevin, Carla M; Hope, Aluko A; Alexander, Sheila; Iwashyna, Theodore J; Boehm, Leanne M; McPeake, Joanne.
  • Eaton TL; Department of Acute and Tertiary Care, School of Nursing, and.
  • Sevin CM; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, Pennsylvania.
  • Hope AA; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan.
  • Alexander S; National Clinician Scholars Program (NCSP), Institute for Healthcare Policy and Innovation, and.
  • Iwashyna TJ; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Boehm LM; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon.
  • McPeake J; Department of Acute and Tertiary Care, School of Nursing, and.
Ann Am Thorac Soc ; 19(11): 1900-1906, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2140773
ABSTRACT
Rationale There are limited data on the impact of the coronavirus disease (COVID-19) pandemic on intensive care unit (ICU) recovery clinic care delivery practices.

Objectives:

We sought to better understand the patient-level factors affecting ICU recovery clinic care and changing clinical thinking during the COVID-19 pandemic. We also sought to understand how the COVID-19 pandemic sparked innovation within ICU recovery clinics.

Methods:

A multicenter qualitative study was conducted with ICU recovery clinic interprofessional clinicians involved with the Critical and Acute Illness Recovery Organization (CAIRO) between February and March 2021. Data were collected using semistructured interviews and were analyzed using thematic analysis. Key themes were organized in a working analytical framework.

Results:

Twenty-nine participants from 15 international sites participated in the study. Participants identified three patient-level key themes that influenced care delivery in ICU recovery programs 1) social isolation, 2) decreased emotional reserve in patients and families, and 3) substantial social care needs. Changes in ICU recovery clinic care delivery occurred at both the clinician level (e.g., growing awareness of healthcare disparities and inequities, recognition of financial effects of illness, refinement of communication skills, increased focus on reconstructing the illness narrative) and the practice level (e.g., expansion of care delivery modes, efforts to integrate social care) in response to each of the patient-level themes. Identified gaps in ICU recovery clinic care delivery during the COVID-19 pandemic included a need for multidisciplinary team members, access to care issues (e.g., digital poverty, health insurance coverage, language barriers), and altered family engagement.

Conclusions:

This study demonstrates that addressing patient-level factors such as efforts to integrate social care, address financial needs, refine provider communication skills (e.g., empathic listening), and enhance focus on reconstructing the illness narrative became important priorities during the ICU recovery clinic visit during the COVID-19 pandemic. We also identified several ongoing gaps in ICU recovery clinic care delivery that highlight the need for interventions focused on the integration of social and clinic services for critical care survivors.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / COVID-19 Type of study: Prognostic study / Qualitative research Limits: Humans Language: English Journal: Ann Am Thorac Soc Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / COVID-19 Type of study: Prognostic study / Qualitative research Limits: Humans Language: English Journal: Ann Am Thorac Soc Year: 2022 Document Type: Article