ICU Recovery Clinic Attendance, Attrition, and Patient Outcomes: The Impact of Severity of Illness, Gender, and Rurality

Abstract

Objectives: The primary purpose is to characterize patients attending ICU recovery clinic and then describe their trajectory of cognitive and emotional health in 1 year.

Design: Retrospective observational study to assess attendance, attrition, and patient outcomes.

Setting: ICU Recovery Clinic.

Patients: Adult patients recently admitted to ICU for sepsis or acute respiratory failure and who were referred to clinic.

Interventions: None.

Measurements and main results: Thirty-eight patients (63%) attended ICU recovery clinic with a mean age of 53.2 ± 16 years (range, 20-82 yr), 42% female and mean Sequential Organ Failure Assessment scores at an ICU admission of 9.4 ± 2.9 participated in outcomes. Twelve patients (32%) were lost to follow up and 12 patients (32%) were transferred to different providers before the end of 1 year. Sequential Organ Failure Assessment scores were negatively associated with health-related quality of life at baseline (r = -0.41; p = 0.033; n = 28) and short term (r = -0.40; p = 0.037; n = 27). Male patients had higher Sequential Organ Failure Assessment scores (mean difference = 2.4; t = 2.779; p = 0.008) and longer hospital length of stay (mean difference = 9.3; t = 2.27; p = 0.029). Female patients had higher scores on Hospital Anxiety and Depression Scale (mean difference = 7.2; t = 2.74; p = 0.01) and Impact of Events Scale-Revised (mean difference = 18.9; t = 2.74; p = 0.011) at the initial follow-up visit. Patients never attending clinic were more likely to live further away, have a tracheotomy, and spent longer time in the ICU.

Conclusions: Attendance and attrition in ICU recovery clinic are related to patient factors (living in rural area) and ICU factors. Data suggest different recovery trajectories exist based on gender, severity of illness, and self-reported outcomes.

Keywords: critical illness; follow-up clinic; patient outcomes; postintensive care syndrome; quality of life.

Figure 1.

Admission to University of Kentucky Medical ICU stratified by the county of residence for 2018.

Figure 2.

Change in Montreal Cognitive Assessment (MOCA). A, No change over time in all patients enrolled (F = 0.48, p = 0.624). B, Improvement in eight patients across three timepoints (repeated-measures analysis of variance F = 4.6; p = 0.031) with pairwise comparison (Bonferroni t test), demonstrating significantly improved from baseline to long term (mean difference = 2.25; t = 2.94; p = 0.034).

Figure 3.

Change in 5D Euro-Quality of Life Visual Analog Scale (EQ-5D-VAS). A, All patients enrolled demonstrating minimal difference in outcomes per time-point (F = 0.19, p = 0.827). B, Improvement in eight patients self-reporting quality of life at all three timepoints with improvements over time (F = 11.2; p = 0.001), with multiple comparisons demonstrating improved from baseline to short term (*mean difference = 15.6; t = 3.96; p = 0.004) and baseline to long term (**mean difference 17.2; t = 4.12; p = 0.002).