Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Valerie Danesh¹, Leanne M Boehm^{2

3}, Tammy L Eaton^{4

5}, Alejandro C Arroliga^{6

7}, Kirby P Mayer⁸, Shelli R Kesler⁹, Rita N Bakhru¹⁰, Michael Baram¹¹, Amy L Bellinghausen¹², Michelle Biehl¹³, Neha S Dangayach¹⁴, Nir M Goldstein¹⁵, K Sarah Hoehn¹⁶, Marjan Islam¹⁷, Sugeet Jagpal¹⁸, Annie B Johnson¹⁹, Sarah E Jolley²⁰, Janet A Kloos²¹, Eric J Mahoney²², Jason H Maley²³, Sara F Martin²⁴, Jakob I McSparron²⁵, Marissa Mery²⁶, Howard Saft²⁷, Lekshmi Santhosh²⁸, Kristin Schwab²⁹, Dario Villalba³⁰, Carla M Sevin³¹, Ashley A Montgomery³²

Affiliations

¹ Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX.
² School of Nursing, Vanderbilt University, Nashville, TN.
³ Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN.
⁴ National Clinician Scholars Program, University of Michigan, Ann Arbor, MI.
⁵ Department of Critical Care Medicine, UPMC Mercy Hospital, Pittsburgh, PA.
⁶ Department of Pulmonary and Critical Care Medicine, Baylor Scott & White Health, Dallas, TX.
⁷ College of Medicine, Texas A&M University, College Station, TX.
⁸ Department of Physical Therapy, University of Kentucky, Lexington, KY.
⁹ School of Nursing, University of Texas at Austin, Austin, TX.
¹⁰ Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC.
¹¹ Department of Medicine, Thomas Jefferson University, Philadelphia, PA.
¹² Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA.
¹³ Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH.
¹⁴ Department of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY.
¹⁵ Department of Medicine, National Jewish Health, Denver, CO.
¹⁶ Department of Pediatrics, University of Chicago, Chicago, IL.
¹⁷ Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
¹⁸ Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
¹⁹ Critical Care, Mayo Clinic, Rochester, MN.
²⁰ Department of Critical Care Medicine, University of Colorado, Anschutz, CO.
²¹ Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Cleveland, OH.
²² Department of Surgery, Tufts Medical Center, Boston, MA.
²³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
²⁴ Department of Palliative Care and Internal Medicine, Vanderbilt University Medical Center, Nashville, TN.
²⁵ Department of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
²⁶ Department of Anesthesiology, University of Texas at Austin Dell Medical School, Austin, TX.
²⁷ Department of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO.
²⁸ Department of Medicine, University of California-San Francisco, San Francisco, CA.
²⁹ Department of Medicine, University of California-Los Angeles, Los Angeles, CA.
³⁰ Department of Respiratory Care, Hospital Chivilcoy, Chivilcoy, Argentina.
³¹ Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
³² Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.

PMID: 35291316
PMCID: PMC8913088
DOI: 10.1097/CCE.0000000000000658

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Valerie Danesh et al. Crit Care Explor. 2022.

. 2022 Mar 9;4(3):e0658.

doi: 10.1097/CCE.0000000000000658. eCollection 2022 Mar.

Authors

Affiliations

¹ Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX.
² School of Nursing, Vanderbilt University, Nashville, TN.
³ Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN.
⁴ National Clinician Scholars Program, University of Michigan, Ann Arbor, MI.
⁵ Department of Critical Care Medicine, UPMC Mercy Hospital, Pittsburgh, PA.
⁶ Department of Pulmonary and Critical Care Medicine, Baylor Scott & White Health, Dallas, TX.
⁷ College of Medicine, Texas A&M University, College Station, TX.
⁸ Department of Physical Therapy, University of Kentucky, Lexington, KY.
⁹ School of Nursing, University of Texas at Austin, Austin, TX.
¹⁰ Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC.
¹¹ Department of Medicine, Thomas Jefferson University, Philadelphia, PA.
¹² Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA.
¹³ Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH.
¹⁴ Department of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY.
¹⁵ Department of Medicine, National Jewish Health, Denver, CO.
¹⁶ Department of Pediatrics, University of Chicago, Chicago, IL.
¹⁷ Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
¹⁸ Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
¹⁹ Critical Care, Mayo Clinic, Rochester, MN.
²⁰ Department of Critical Care Medicine, University of Colorado, Anschutz, CO.
²¹ Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Cleveland, OH.
²² Department of Surgery, Tufts Medical Center, Boston, MA.
²³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
²⁴ Department of Palliative Care and Internal Medicine, Vanderbilt University Medical Center, Nashville, TN.
²⁵ Department of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
²⁶ Department of Anesthesiology, University of Texas at Austin Dell Medical School, Austin, TX.
²⁷ Department of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO.
²⁸ Department of Medicine, University of California-San Francisco, San Francisco, CA.
²⁹ Department of Medicine, University of California-Los Angeles, Los Angeles, CA.
³⁰ Department of Respiratory Care, Hospital Chivilcoy, Chivilcoy, Argentina.
³¹ Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
³² Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.

PMID: 35291316
PMCID: PMC8913088
DOI: 10.1097/CCE.0000000000000658

Abstract

The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States.

Design: Cross-sectional survey.

Setting: Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated.

Patients: None.

Interventions: None.

Measurement and main results: RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%).

Conclusions: Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

Keywords: administration; healthcare delivery; postacute sequelae of COVID-19; postintensive care syndrome; severe acute respiratory syndrome coronavirus-2.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
ICU Recovery Clinic start dates. *Blue* refers to ICU Recovery Clinic.

**Figure 2.**
ICU Recovery Clinic (ICU-RC) and COVID Recovery Clinic (COVID-RC) start dates. *Blue* refers to ICU-RC, and *red* indicates COVID-RC.

See this image and copyright information in PMC

References

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Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Affiliations

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources