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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 Agosto;81(8):865-75
Feasibility of Post-Intensive Care Unit Clinics: an observational cohort study of two different approaches
Dettling-Ihnenfeldt D. S. 1, De Graaff A. E. 2, Nollet F. 1, Van Der Schaaf M. 1 ✉
1 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands;
2 Department of Intensive Care, Tergooi Hilversum, The Netherlands
BACKGROUND: Post-ICU clinics have been advocated to reduce long-term physical and psychological impairments among ICU survivors. A format for optimal structure, timing, and care content has not yet been established. We developed and implemented two post-ICU clinics in different hospital settings and evaluated the feasibility.
METHODS: In this prospective cohort study ICU-survivors of a university hospital (AMC) and a general hospital (TG), who were mechanically ventilated ≥2 days and discharged to their homes, were invited to the post-ICU clinic one month after hospital discharge (AMC) or three months after ICU discharge (TG). Feasibility was evaluated as 1) the number of eligible ICU-survivors and the proportion that attended; 2) the prevalence of ICU-related abnormalities, that required referral for further treatment; and 3) patient satisfaction.
RESULTS: Forty-five of 629 AMC-patients and 70 of 142 TG-patients were eligible for the post-ICU clinic. Of these, 49% and 67% respectively, visited the outpatient clinic (P=0.026). The majority of all screened patients had functional restrictions, and 68% required referral for further diagnosis and treatment. Patient satisfaction was high.
CONCLUSION: This study provides valuable information to support the implementation of post-ICU clinics. The use of validated screening instruments facilitates the identification of patients with need for further treatment. Early in-hospital screening and recruiting patients at highest risk for adverse outcome could be a more targeted approach to achieve greater benefit.