Redesigning our follow up pathway for post critical care discharges

ABSTRACT

Introduction: During theCOVID-19 pandemic we were faced with a large number of critical care discharges recovering from prolonged intensive care admission and severe lung injury at our 500 bed hospital in the South East of England. These patients often had complex rehabilitation needs and rehabilitation of these patients had been challenged by social distancing and the reconfiguration of many outpatient departments. Prior to the covid pandemic our rehabilitation pathway consisted of a nurse led follow up that focussed on psychological recovery and, following initial assessment, physiotherapy that included musculoskeletal therapy, 11 or small group exercises and respiratory physiotherapy. We developed a new pathway during the COVID-19 pandemic that united these above services into a one-stop multidisciplinary service that included clinician follow up and utilised smart watch technology from Fitbit watches to aid recovery of our ICU discharges. Method: Prior to discharge patients had a comprehensive set of assessments to identify physical and psychological needs. This included an incremental shuttlewalk test, oneminute sit-to-stand test, patient health questionnaire-9 (PHQ-9), generalized anxiety depression questionnaire -7 and Chelsea critical care physical assessment (CPAX). Patients were offered an exercise programme, depending on level of function, and referred to appropriate community services as required. Patients received Fitbit charge 3watches and were asked towear these as often as they felt able. At three months following discharge patients attended a multidisciplinary clinic consisting of an intensive care clinician, physiotherapist, and nursing staff. Outcome measures were re-assessed, and the patient had access to ongoing physio, nursing and medical input to support their recovery. Fitbit data was reviewed and incorporated into future goal setting. In addition, patients were invited to a relative and patient support group as an opportunity to meet other critical care survivors and for their relatives to share their experiences of recovery. They were also offered the chance to visit the ICU to aid physiological recovery. Results: The one-stop nature of the clinic allowed a resource efficient means for multi disciplinary care to be delivered to patients. The majority of patients found the support group extremely beneficial. Patients reported they found it helpful being able to share experiences, listen to others and see people at different stages in their recovery. Relatives also found the experience useful to deal with the traumatic experience of a critically ill loved one. Smart watches were well received by patients and over 80% of patients felt the watch aided their recovery. The watches also added a unique dimension to the MDT meeting, able to pick up changes in daily activity levels, rapidly alerting the clinician to a potential problem in that patient. Conclusion: The service is continually evolving. Future plans aim;to use smart watches for all ICU discharges with an integrated app to promote recovery and allow remote feedback, to use a Post-ICU Presentation Screen (PICUPS) and rehabilitation prescription to inform rehabilitation needs and to include a psychologist into the clinic to improve patient recovery after ICU admission.