Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center

Abstract

Purpose: To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States.

Materials and methods: A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care.

Results: 218/307 referred patients (71%) survived to hospital discharge; 62 (28% of survivors) were seen in clinic. Median time from discharge to ICU-RC visit was 29days. At initial evaluation, 64% of patients had clinically meaningful cognitive impairment. Anxiety and depression were present in 37% and 27% of patients, respectively. One in three patients was unable to ambulate independently; median 6min walk distance was 56% predicted. Of 47 previously working patients, 7 (15%) had returned to work. Case management and referral services were provided 142 times. The median number of interventions per patient was 4.

Conclusions: An ICU-RC identified a high prevalence of cognitive impairment, anxiety, depression, physical debility, lifestyle changes, and medication-related problems warranting intervention. Whether an ICU-RC can improve ICU recovery in the US should be investigated in a systematic way.

Keywords: Cognitive impairment; Delirium; ICU follow-up clinic; Models of care; Post intensive care syndrome.

Figure 1. Flow diagram of patient recruitment and follow-up in the Vanderbilt Intensive Care Unit Recovery Center (ICU-RC)

Definition of abbreviations: ICU= intensive care unit; SNF=skilled nursing facility; ^aPatients could meet more than one exclusion criteria for the clinic. ^bPatients could have more than one reason for not being scheduled in the ICU Recovery Center. ^c56 patients had complete data collected (i.e., were seen by all providers).