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Intensive Care Med. 2019 Jul;45(7):939-947. doi: 10.1007/s00134-019-05647-5. Epub 2019 Jun 4.

Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives.

Author information

1
Department of Physiotherapy, Western Health, Sunshine Hospital, Melbourne, Australia. Kimberley.haines@wh.org.au.
2
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. Kimberley.haines@wh.org.au.
3
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
4
Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.
5
School of Nursing, Vanderbilt University, Nashville, TN, USA.
6
Critical Care Medicine, Springfield Clinic, Springfield, IL, USA.
7
Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
8
Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
9
Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA.
10
Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA.
11
Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
12
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
13
Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA.
14
School of Nursing, University of California San Francisco, San Francisco, CA, USA.
15
Guy's and St Thomas' NHS Foundation Trust, London, UK.
16
Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA.
17
Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, New York, USA.
18
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
19
Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
20
Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN, USA.
21
University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
22
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
23
Department of Health and Human Services, Safer Care Victoria, Melbourne, Australia.
24
Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
25
Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Kentucky, USA.
26
School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK.
27
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA.
28
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.
29
Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
30
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Maryland, USA.
31
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Maryland, USA.
32
Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA.
33
Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.
34
Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
35
Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
36
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
37
Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK. Joanne.mcpeake@glasgow.ac.uk.
38
School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK. Joanne.mcpeake@glasgow.ac.uk.

Abstract

OBJECTIVE:

To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs.

METHODS:

Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine's THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data.

RESULTS:

Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs-new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU-former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them-clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician's own understanding of patient experience-there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work-this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes.

CONCLUSIONS:

The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area.

KEYWORDS:

Intensive care unit follow-up clinics; Peer support; Post-intensive care syndrome

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