Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia

Abstract

BackgroundCritical care survivors experience multiple care transitions, with no formal follow-up care pathway. Research QuestionWhat are the potential solutions to improve the communication between treating teams and integration of care following an Intensive Care Unit (ICU) admission – from the perspective of patients, their caregivers, intensivists, and General Practitioners (GPs) from diverse socioeconomic areas? Study Design& Methods: Qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework Analysis was used to analyse data, and to identify solutions to improve the integration of care post-hospital discharge. Patients were previously mechanically ventilated for >24 hours in ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network. ResultsForty-six interviews with clinicians, patients and caregivers were completed (15 Intensivists, 8 GPs, 15 patients and 8 caregivers). Three higher-level feedback loops were identified, that comprised of ten themes. Feedback loop 1: ICU and primary care collaboration: 1. Developing collaborative relationships between the ICU and primary care, 2. Providing interprofessional education and resources to support primary care, 3. Improving role clarity for patient follow-up care; Feedback loop 2: Developing mechanisms for improved communication across the care continuum: 4. Timely, concise information sharing with primary care on post-ICU recovery, 5. Survivorship focused information sharing across the continuum of care, 6. Empowering patients and caregivers in self-management; 7. Creation of a care coordinator role for survivors; and Feedback loop 3: Learning from post-ICU outcomes to improve future care: 8. Developing comprehensive post-ICU care pathways, 9. Enhancing support for patients after hospital, 10. Integration of post-ICU outcomes within the ICU to improve clinician morale and understanding. InterpretationPractical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.