Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors.

Publisher: Cambridge University Press Country of Publication: England NLM ID: 9007918 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1741-203X (Electronic) Linking ISSN: 10416102 NLM ISO Abbreviation: Int Psychogeriatr Subsets: MEDLINE

Publication: 2004- : Cambridge, UK : Cambridge University Press
Original Publication: New York : Springer Pub. Co., c1989-

Critical Illness*; Caregivers/*psychology ; Continuity of Patient Care/*organization & administration ; Critical Care/*organization & administration ; Intensive Care Units/*organization & administration ; Survivors/*psychology; Aged ; Aging ; Cognition/physiology ; Cooperative Behavior ; Delirium ; Depression ; Female ; Frailty ; Health Services for the Aged/organization & administration ; Humans ; Implementation Science ; Male ; Stress, Psychological

Background: As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). We describe how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI).
Methods: The CCRC was designed using an eight-step process known as the AI Science Playbook. Patients who required mechanical ventilation or were delirious ≥48 hours during their ICU stay were enrolled in the CCRC. One hundred twenty subjects who completed baseline HABC-M CG assessments and had demographics collected were included in the analysis to identify baseline characteristics that correlated with higher HABC-M CG scores. A subset of patients and caregivers also participated in focus group interviews to describe their perceptions of PICS.
Results: Quantitative analyses showed that the cognitive impairment was a major concern of caregivers. Focus group data also confirmed that caregivers of ICU survivors (n = 8) were more likely to perceive cognitive and mental health symptoms than ICU survivors (n = 10). Caregivers also described a need for ongoing psychoeducation about PICS, particularly cognitive and mental health symptoms, and for ongoing support from other caregivers with similar experiences.
Conclusions: Our study demonstrated how the AI Science Playbook was used to build the first ICU survivor clinic in the United States. Caregivers of ICU survivors continue to struggle with PICS, particularly cognitive impairment, months to years after discharge. Future studies will need to examine whether the CCRC model of care can be adapted to other complex patient populations seen by health-care professionals.

Comment in: Int Psychogeriatr. 2020 Dec;32(12):1387-1388. (PMID: 33377861)

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P30 AG010133 United States AG NIA NIH HHS; UL1 TR001108 United States TR NCATS NIH HHS; R01 AG055424 United States AG NIA NIH HHS; R01 AG055391 United States AG NIA NIH HHS; R01 HL131730 United States HL NHLBI NIH HHS; R01 AG030618 United States AG NIA NIH HHS; R01 AG040220 United States AG NIA NIH HHS; R01 AG056325 United States AG NIA NIH HHS; P30 HS024384 United States HS AHRQ HHS; SB1 AG037357 United States AG NIA NIH HHS

Keywords: PICS; aging; caregiver stress; cognition; critical care; delirium; depression; frailty

postintensive care syndrome

Date Created: 20190831 Date Completed: 20210624 Latest Revision: 20220330

20221213

PMC7048643

10.1017/S1041610219000553

31466536