Lancashire and South Cumbria Critical Care Network Follow Up Clinic Evaluation Project

ABSTRACT

Introduction: Admission and survival from critical care is not without its far-reaching consequences to both the patient and their families. Follow-up clinic for critical care patients is something that has been established to try to 'mop up' some of these consequences. However, resource allocation to this vital line for many patients is patchy and often inadequate. Within the LSCCC Network there are Four Trusts with critical care follow up services. Three sites agreed to participate in the project to evaluate the issues patients report at clinics and the provision of services for ongoing support for these patients. Objectives: To evaluate the physical, functional, psychological and cognitive issues patient identify at follow up clinic reviews and the service provision for ongoing support for these patients. Methods: From the period of July 2020 -July 2021 we collected data on patients attending follow up clinics at three sites. We collected basic demographic data, level of care, type of ventilatory support, length of ventilation, length of critical care and hospital stay and COVID-19 status. We used the EQ-5D Health Related Quality of Life score (HRQoL) questionnaire, Health Score and Trauma Screening Questionnaire to assess how respondents rated their own health. We identified physical/ functional and psychological issues patients reported at the clinic appointments. We identified onward referrals to other specialities and if these services were available. We identified if patients had returned to work after their admission to critical care and whether patients would benefit from further Follow Up appointments. Results: We collected data on 249 patients. 58% of these were male and 42% of these patients were admitted due to COVID-19. The median age of our patients was 59 (16-86), with 53% of patients requiring Level 3 care. The median length of invasive ventilation was nine days (0-88 days), noninvasive ventilation was 2 days (0-16 days) and median total ventilation was 11 days (0-100 days). The median length of Critical Care stay was 15 days (3-108 days), and the median hospital length of stay was 28 days (4-280 days). The HRQoL data identified issues in all the dimensions of quality of life and highlighted the problems patients face in their recovery from critical illness. The health score also identified that most patients felt their illness has impacted on the overall health status with some patients reporting significant reductions. The most common physical issues reported were fatigue and muscle weakness, however there was a range of physical issues identified showing the complexity of issues patients have during their recovery. The psychological issues highlighted high levels of anxiety in patients and sleep disturbance, as well as delusional memories and cognitive issues. The Trauma Screening questionnaire also identified self-reported psychological issues with the median score 3 but some patients reporting scores of 10 indicating severe psychological distress. The data identified patients requiring a high number of onward referrals to Medical and Allied Health Professional services to support their recovery. This is due to their being limited clinicians present in the Follow Up Clinics at the different sites. Most clinics had services available for onward referral except Psychology which was only available in one site. In the patients who were working prior to the period of hospitalisation only a limited number had been able to return to work by the time of the clinic appointment. Nearly a quarter of patients were identified as potentially benefitting from further appointments. Conclusion: We identified that patients in the LSSCC Network who are admitted to Critical care, have significant impairments following a stay in critical care. They often require referral to further specialty services which are not always available within the follow up clinic that they attend. However, what is clear from our data is that our patients they need access to a range of Health and Social Care Professionals when they atte d Follow Up Clinics and ability to access further ongoing health and support services.