VIRTUAL CRITICAL CARE FOLLOW UP
Dr Christiana Page, Paula O’Shea, Monika Krupa, Dr Rosalba Spiritoso
Cardiothoracic and General Intensive Care Unit, St George’s Hospital, London, UK
Critical care admissions can be associated with physical, cognitive and psychological sequelae after discharge, which can last up to months or years. This collective of symptoms has been labelled as ‘post intensive care syndrome’ (PICS)1, and can affect relatives as well as the patient. Currently, understanding of PICS is relatively limited. Risk increases with length of admission, though anyone admitted to intensive care can experience it. In 2015, there were 258, 956 critical care admissions in England, more than the previous year, and the average length of stay was 9 days.2 As more and more patients are surviving critical illness, it is important to address what their quality of life is following discharge. In 2009, the National Institute for Clinical Excellence (NICE) introduced guidance that critical care patients should be followed up 2-3 months after discharge.3 However, a study in 2013 found that despite an increased awareness of need for follow up, there was a low prevalence of these services available in the United Kingdom (UK).3 Reasons for this included lack of funding, lack of resources and prioritisation to other clinical areas.4
The Guidelines for Provision of Intensive Care Services (GPICS) recommend that patients should be followed up at 2, 6 and 12 months following discharge, and that invitation criteria should be based on length of stay or risk.5 Since May 2014, St George’s Hospital has established an outpatient follow up service for patients discharged from intensive care unit (ICU). Invitations are extended to patients who were admitted to General Intensive Care Unit >4 days or to Cardiothoracic Intensive Care Unit >5 days. The clinic aims to run once a week and see 4-8 patients per session. Outpatient clinic requires a significant amount of time and staff resources to provide a proper assessment. In these difficult financial times for the National Health Service, it is challenging to meet the standards set out by NICE and GPICS. Additionally, it was highlighted that there were high ‘did not attend’ (DNA) rates within our service, resulting in an inappropriate use of already limited resources. With the aim to improve on this, we recently piloted a virtual follow up clinic.