Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

Abstract

Objective: To comprehensively update and survey the current provision of recovery, rehabilitation and follow-up services for adult critical care patients across the UK.

Design: Cross-sectional, self-administered, predominantly closed-question, electronic, online survey.

Setting: Institutions providing adult critical care services identified from national databases.

Participants: Multiprofessional critical care clinicians delivering services at each site.

Results: Responses from 176 UK hospital sites were included (176/242, 72.7%). Inpatient recovery and follow-up services were present at 127/176 (72.2%) sites, adopting multiple formats of delivery and primarily delivered by nurses (n=115/127, 90.6%). Outpatient services ran at 130 sites (73.9%), predominantly as outpatient clinics. Most services (n=108/130, 83.1%) were co-delivered by two or more healthcare professionals, typically nurse/intensive care unit (ICU) physician (n=29/130, 22.3%) or nurse/ICU physician/physiotherapist (n=19/130, 14.6%) teams. Clinical psychology was most frequently lacking from inpatient or outpatient services. Lack of funding was consistently the primary barrier to service provision, with other barriers including logistical and service prioritisation factors indicating that infrastructure and profile for services remain inadequate. Posthospital discharge physical rehabilitation programmes were relatively few (n=31/176, 17.6%), but peer support services were available in nearly half of responding institutions (n=85/176, 48.3%). The effects of the COVID-19 pandemic resulted in either increasing, decreasing or reformatting service provision. Future plans for long-term service transformation focus on expansion of current, and establishment of new, outpatient services.

Conclusion: Overall, these data demonstrate a proliferation of recovery, follow-up and rehabilitation services for critically ill adults in the past decade across the UK, although service gaps remain suggesting further work is required for guideline implementation. Findings can be used to enhance survivorship for critically ill adults, inform policymakers and commissioners, and provide comparative data and experiential insights for clinicians designing models of care in international healthcare jurisdictions.

Keywords: adult intensive & critical care; rehabilitation medicine.

Figure 1

Composition (A) and size (B) of multiprofessional teams delivering outpatient recovery and follow-up services. (A) Bar graph depicts number of outpatient services with various multiprofessional team combinations. Detail of each corresponding profession is summarised in the table below. Total number of services=130. Online supplemental file 2 table E1 provides additional data on exact frequencies of occurrence of each combination. N (%) detailed by each profession reports the frequency of involvement of each profession across all 130 outpatient services. n=14 (10.8%) of ‘other’ professions involved Citizens Advice Bureau, n=4; volunteers, n=2; carers association, n=2; cognitive behavioural therapy, rehabilitation team, advanced critical care practitioner, patient liaison service, head injury specialist, health promotion advisor, all n=1. Generic rehabilitation assistants are healthcare workers (some may have healthcare qualifications, but this is not essential) who offer support to qualified clinicians with carrying out various rehabilitation activities with patients. (B) Pie chart summarises the relative proportion of each team size (regardless of composition). GP, general practitioner; GRA, generic rehabilitation assistant; OT, occupational therapist; PT, physiotherapist; SLT, speech and language therapist.