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 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

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.

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

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

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

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?

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

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

Results - Patients 27 Medical 28 Surgical - 13 elective cases

Results Average LOS 18.1 – Average LOS level days – Average LOS level days

Clinic Interventions 107 interventions made 1.95 interventions / patient

Other Interventions 2 psychiatric referrals were made for PTSD

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

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

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

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

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

Is there a difference between interventions for surgical vs medical?

What’s everybody else in Wales doing?

ICU’s across Wales were contacted

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.

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

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

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

Questions?

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

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