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Crit Care Med. 2019 Sep;47(9):1194-1200. doi: 10.1097/CCM.0000000000003818.

Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives.

Author information

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

Abstract

OBJECTIVES:

Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.

DESIGN:

Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.

SETTING:

Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents.

SUBJECTS:

Clinicians from 21 sites.

MEASUREMENT AND MAIN RESULTS:

Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.

CONCLUSIONS:

Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.

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