Establishing a novel multidisciplinary, non-tertiary ICU aftercare clinic: Patient profiles and outcomes

Establishing a novel multidisciplinary, non-tertiary ICU aftercare clinic: Patient profiles and outcomes

Courtney Gough¹, Hai-Yun Li¹, Dale Edgar^1,2,3, Ellie Newman¹, Alexander Das⁴, Mark Shea⁴, David Blythe<sup>4

1</sup>Department of Physiotherapy, Armadale Kalamunda Group Health Service, Mt Nasura, WA, Australia
²Safety and Quality, Armadale Kalamunda Group Health Service, Mt Nasura, WA, Australia
³Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
⁴Intensive Care Unit, Armadale Health Service , Mt Nasura, WA, Australia

Abstract

Mortality continues to decline with advances in critical care, leading increasing “ICU survivors”. Research establishes that a stay in ICU may be followed by severe physical, psychological and cognitive problems. This variable cluster of symptoms, known as Post Intensive Care Syndrome (PICS), is emerging as a burgeoning public health burden. To understand and address the challenges of PICS in a non-tertiary ICU context, a novel ambulatory service was established at Armadale Health Service (AHS), in 2018. The ICU aftercare clinic invited adults, 6-8 weeks after discharge for review. Patients admitted primarily for mental health or self-harm issues were followed up elsewhere and excluded from the cohort.

Medical, nursing and physiotherapy staff assessed symptomology, functional, frailty, psychological, cognitive and quality of life outcomes to inform onward referrals. The expanded results from patients recruited to Nov 2021 will be presented to profile the establishment cohort attending prior to the hiatus of the clinic due to the COVID pandemic.

The clinic sample included 162 patients with mean: age 64(+/-17) yrs; length of stay 7(+/-5) dys; clinical frailty score 3.5 / 9 (+/-1.3); and APACHE III 54 / 299(+/-17). Difficulties reported included vision(21%); hearing(12%); swallowing(11%); and, sexual function(11%). Onward referrals sought cardiac; respiratory; renal; gasteroenterology; neurology; pain; ENT; general surgery; general and geriatric medicine; and, rheumatology service input. Multivariable modelling indicated frailty at admission was a predictor of poorer QoL responses at clinics. The AHS ICU aftercare clinic has recommenced, and lessons learned that informed the 2023 iteration of the clinic will be presented.

Biography

Courtney is a Senior Physiotherapist who has established herself as a clinical leader in the critical care area, including the integrated care and follow up of patients after ICU admission.