Post-intensive care syndrome following cardiothoracic critical care: Feasibility of a complex intervention
Philip Henderson, Tara Quasim, Annette Asher, Lucy Campbell, Malcolm Daniel, Lisa Davey, Helen Devine, Martyn Gall, Pamela Mactavish, Karen Mcgroarty, Fiona Nolan, Colin Purdie, Isma Quasim, John Sharp, Martin Shaw, Theodore J. Iwashyna, Joanne McPeake
Academic Unit of Anaesthesia, Pain & Critical Care Medicine, University of Glasgow, Glasgow, UK. E-mail: Philip.Henderson@ggc.scot.nhs.uk
Objectives: To describe the long-term outcomes of cardiac intensive care unit patients and their primary caregivers, and to explore the feasibility of implementing a complex intervention, designed to support problems associated with post-intensive care syndrome and post-intensive care syndrome–family, in the year following discharge from the cardiac intensive care unit.
Design: A complex multidisciplinary rehabilitation programme, delivered as a quality improvement initiative, in a single centre in the West of Scotland. Outcomes were measured using surveys of health related quality of life, self efficacy, anxiety, depression, pain, caregiver strain, and insomnia.
Participants: Patients and their caregivers were invited to participate 12 weeks after hospital discharge. Twenty-seven patients and 23 caregivers attended the programme.
Results: Over 90% of patients had problems in at least one quality of life domain at baseline, 41% of patients had symptoms of anxiety and 22% had symptoms of depression. During the baseline visit, caregiver strain was present in 20% of caregivers, 57% had symptoms of anxiety, and 35% had symptoms of depression. Improvements in outcomes were seen in both patients and caregivers at 1-year follow-up. The programme was implemented, and iterative learning obtained about the content and the operationalization of the service, in order to understand feasibility.
Conclusion: This small-scale quality improvement project has demonstrated that this complex multidisciplinary rehabilitation programme is feasible and has positive implications for patients following discharge from the cardiac intensive care unit, and their caregivers.
Patients, and relatives (or caregivers) of patients, treated in specialist intensive care units often only have access to limited recovery programmes focussing on a single disease. For patients treated in general intensive care units a recovery programme called InS:PIRE has been developed. The programme runs over multiple weeks, combining healthcare teams with social and financial help, and involves community organizations. It also brings groups of patients and relatives together so that they can help each other (known as peer support). This study describes the process of adapting the InS:PIRE programme for those treated in a specialist heart and lung centre. The problems these patients and relatives experience in the year after their illness is described, demonstrating that these issues are similar to those experienced after general intensive care. The results show that this model of recovery is possible in this setting and appears to be valued by the participating patients and relatives.
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