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Novel digitally enabled care pathway to support postintensive care recovery and goal attainment following critical illness
  1. Louise Rose1,2,
  2. Chloe Apps2,3,
  3. Kate Brooks2,
  4. Ella Terblanche1,
  5. Nicholas Hart2,3,
  6. Joel Meyer2,3
  1. 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
  2. 2Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3Faculty of Life Sciences & Medicine, King’s College London, London, UK
  1. Correspondence to Professor Louise Rose, King's College London, London WC2R 2LS, UK; louise.rose{at}kcl.ac.uk

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Summary box

What are the new findings?

  • We present an innovative digital recovery pathway incorporating individualised goal setting, goal attainment scaling monitoring, symptom monitoring and tailored informational e-resources for intensive care unit (ICU) survivors and their families.

How might it impact on healthcare in the future?

  • Immediate healthcare and rehabilitation needs of ICU survivors following hospital discharge are better met.

  • Healthcare literacy needs of ICU survivors and their family members are addressed and tailored to individual need.

  • Reduced unscheduled utilisation of existing acute and community healthcare services by ICU survivors.

Introduction

Intensive care unit (ICU) survivors, particularly with a protracted length of stay such as those mechanically ventilated for COVID-19 pneumonitis, experience lasting physical, cognitive and psychological challenges that impede their recovery and functional capability.1 Survivors also experience substantial symptom burden including breathlessness, extreme fatigue and pain.2 Together, the healthcare issues faced by ICU survivors are frequently referred to as postintensive care syndrome (PICS). Family members acting as informal caregivers experience substantial psychosocial burden and in some cases loss of employment and financial difficulties due to their informal caregiver commitments.3 Unfortunately, fragmentation in healthcare delivery following transfer from the ICU to an in-patient ward location, and following hospital discharge, is all too common.4 This fragmentation results in mismatches in the healthcare services needed and those received, information loss, treatment omissions, hospital readmission, and poor patient and family experience, all of which may interfere with recovery.5–7

Despite the well-established recovery challenges faced by ICU survivors and their family members, development of a recovery plan and provision of follow-up recovery services are highly variable, and in some jurisdictions extremely limited.8 Individualised recovery goal setting, although the standard of care across many areas of rehabilitation9 is not routine for ICU survivors. Virtual care and telemedicine may provide a solution to bridge the fragmentation prevalent across arbitrary healthcare system boundaries and thus enable individualised …

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Footnotes

  • Twitter @ProfLouiseR, @KateBrooksOT

  • Contributors LR, NH and JM conceived of the innovation. LR, CA and JM designed the ICU recovery pathway and worked with the programming team; CA, KB and ET contributed to data collection; LR prepared the initial manuscript draft, all authors contributed to manuscript revisions.

  • Funding This service innovation is funded by the Guy’s and St Thomas’ Charity.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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