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Critical Care Follow Up Clinics Are they effective?

Critical Care Follow Up Clinics Are they effective?. Charlotte Carvell David Owen. Introduction. Critical Care – evolving……. Introduction. ICU patients - sickest + need the most support Many survivors experience a range of physical and psychological problems. Introduction .

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Critical Care Follow Up Clinics Are they effective?

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  1. Critical Care Follow Up Clinics Are they effective? Charlotte Carvell David Owen

  2. Introduction • Critical Care – evolving……

  3. Introduction • ICU patients - sickest + need the most support • Many survivors experience a range of physical and psychological problems

  4. Introduction • Problems don’t stop at the point of discharge • Problems often complex and not easily suited to current follow up systems • Problems are often not recognised or treated. • Patients can easily be “lost” in a sometimes hectic system

  5. Introduction • Nice guideline 83 • suggests that rehabilitation strategies for these patients could offer many benefits… • reducing length of hospital stay post ICU • reduce readmission rates • reducing use of primary care resources • expedite patients return to their previous level of activity.

  6. Introduction • A Critical Care Follow Up clinic introduced in Morriston Hospital, in an attempt to address some of these issues.

  7. The Clinic • Critical Care Consultant, Band 7 nurse, Physiotherapist • Dedicated secretarial support • Approx. 4 patients seen / clinic / fortnightly • Patient selection – “very loose” • 45 minutes / patient • Not funded • No formal Out Patient facilities / support

  8. Aim of Clinic • Holistically review / investigate and manage needs and problems • Co-ordinate Care • Establish suitability for physiotherapy based rehabilitation (and RCT) • Give advice e.g. smoking cessation, weight loss • Discuss the patients recollections and experiences • Enquire about family experiences • Ask for informal feedback

  9. Study - Aims • Determine • “effectiveness” of the clinic - numbers and types of interventions / patients seen • Relationship between LOS and no. of interventions • Relationship between Level of Care and no. of interventions • Relationship between original problem and no. of interventions • Which patient groups benefit most?

  10. Methods • 1 years activity reviewed - Jan 2011 – Jan 2012 • Length of time from discharge to clinic appt. • The “type” of patient + their original level of care • Their length of stay on ICU • The number of interventions made in clinic • Which patients received the most interventions

  11. Results • 55 patients • Male 32, Female 23 • Average age 59.9yrs • 25 Level 2 patients • 30 Level 3 patients

  12. Results - Patients • 27 Medical • 28 Surgical - 13 elective cases

  13. Results • Average LOS 18.1 • Average LOS level 2 17.80 days • Average LOS level 3 18.27 days

  14. Clinic Interventions • 107 interventions made • 1.95 interventions / patient

  15. Other Interventions • 2 psychiatric referrals were made for PTSD

  16. Is there a relationship between LOS and no. of Interventions?

  17. LOS and Number of Interventions • Regression analysis - a slight positive association with increasing length of stay and increasing number of interventions. • R square 0.07 / P = 0.046

  18. Is there a relationship between Level of Care and No. of Interventions?

  19. Levels of Care and No. of Interventions • Level 2 patients - 46 interventions • 1.84 interventions / level 2 patient • Level 3 patients - 61 interventions • 2.03 interventions / level 3 patient

  20. Is there a relationship between original problem and No. of Interventions?

  21. Is there a difference between interventions for surgical vs medical?

  22. What’s everybody else in Wales doing?

  23. What’s everybody else in Wales doing? • ICU’s across Wales were contacted

  24. What’s everybody else in Wales doing? • 4/16 – Critical Care Follow up clinics • Glan Clwyd - nurse led service - patients invited back to the unit • Nevill Hall – nurse led and diary based • Wrexham Maelor – medical + nursing led clinic • Princess Of Wales - cancelled clinic - lack of funding.

  25. What’s everybody else in Wales doing? • Limited and varied ICU Follow Up services • No funding.

  26. Summary • Help co-ordinate care • Majority required at least 1 intervention and often more • Patients with longer LOS, who were Level 3 and respiratory appear to benefit most

  27. Conclusions • ICU Follow Up Clinics appear to be beneficial • But…..varied and limited in Wales with no funding.

  28. Questions?

  29. Respiratory patients needed the most interventions 32.7% • Followed by Cardiac (16.8%), Mixed picture (12.2%) and GI (11.2%)

  30. Results • Average time to follow up from discharge 105 days • 65% seen in under 3 months

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