Post-ICU Care: A Qualitative Analysis of Patient Priorities and Implications for Redesign.
Scheunemann LP., White JS., Prinjha S., Hamm ME., Girard TD., Skidmore ER., Reynolds CF., Leland NE.
RATIONALE: While survival during critical illness is improving, little evidence exists to guide post-intensive care unit (ICU) care. Understanding patients' needs and priorities is fundamental to improving care quality. OBJECTIVE: To describe the evolution of patients' priorities for recovery across the spectrum of post-ICU care. METHODS: This was a secondary analysis of 39 semi-structured interviews conducted from 2005-2006, in participants' homes 19 days to 11 years after hospital discharge post-critical illness. Adult critical illness survivors (n=39) ≥ 20 years old from multiple ICUs across the United Kingdom were purposively selected to maximize diversity with respect to time since diagnosis, disease severity, gender, age, ethnicity, socio-economic group/status, region. age, ICU admitting diagnoses, and length of stay. We used the method of qualitative description to characterize patients' priorities for recovery and their evolution within and between individual patients, across three post-ICU periods: ICU transition to wards, early period (approximately the first 2 months) after discharge home, and late period (>2 months) after discharge home. RESULTS: The analysis revealed 12 core patient priorities during recovery: feeling safe, being comfortable, engaging in mobility, participating in self-care, asserting personhood, connecting with people, ensuring family well-being, going home, restoring psychological health, restoring physical health, resuming previous roles and routines, and seeking new life experiences. In general, priorities evolved from those pertaining to basic survival during the stay on wards to being broader and more aspirational by the late post-discharge period. CONCLUSIONS: Understanding patients' priorities for post-ICU care is critical for developing stakeholder-driven clinical guidelines. Engaging other stakeholders (e.g., family members, healthcare providers, institutionalized and frail older adults) to inform the development of clinical guidelines for post-ICU care, together with the barriers and facilitators faced in achieving patient- and family-centered care, is an important next step.