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Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia.
Leggett, Nina; Emery, Kate; Rollinson, Thomas C; Deane, Adam M; French, Craig; Manski-Nankervis, Jo-Anne; Eastwood, Glenn; Miles, Briannah; Witherspoon, Sophie; Stewart, Jonathan; Merolli, Mark; Ali Abdelhamid, Yasmine; Haines, Kimberley J.
Afiliação
  • Leggett N; Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia. Electronic address: nleggett@student.unimelb.edu.au.
  • Emery K; Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.
  • Rollinson TC; Department of Physiotherapy, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
  • Deane AM; Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia.
  • French C; Department of Intensive Care, Western Health, Melbourne, VIC, Australia.
  • Manski-Nankervis JA; Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.
  • Eastwood G; Department of Critical Care, Austin Health, Melbourne, VIC, Australia.
  • Miles B; Department of Intensive Care, Melbourne Health, Melbourne, VIC, Australia.
  • Witherspoon S; Mount Isa Base Hospital, Mount Isa, QLD, Australia.
  • Stewart J; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
  • Merolli M; Centre for Digital Transformation of Health, the University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, the University of Melbourne, Melbourne, VIC, Australia.
  • Ali Abdelhamid Y; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
  • Haines KJ; Department of Physiotherapy, Western Health, Melbourne, VIC, Australia; Department of Critical Care, School of Medicine, the University of Melbourne, Melbourne, VIC, Australia.
Chest ; 166(1): 95-106, 2024 Jul.
Article em En | MEDLINE | ID: mdl-38382876
ABSTRACT

BACKGROUND:

Critical care survivors experience multiple care transitions, with no formal follow-up care pathway. RESEARCH QUESTION What are the potential solutions to improve the communication between treating teams and integration of care following an ICU admission, from the perspective of patients, their caregivers, intensivists, and general practitioners (GPs) from diverse socioeconomic areas? STUDY DESIGN AND

METHODS:

This study included a qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework analysis was used to analyze data and to identify solutions to improve the integration of care following hospital discharge. Patients were previously mechanically ventilated for > 24 h in the ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network.

RESULTS:

Forty-six interviews with clinicians, patients, and caregivers were completed (15 intensivists, eight GPs, 15 patients, and eight caregivers). Three higher level feedback loops were identified that comprised 10 themes. Feedback loop 1 was an ICU and primary care collaboration. It included the following (1) developing collaborative relationships between the ICU and primary care; (2) providing interprofessional education and resources to support primary care; and (3) improving role clarity for patient follow-up care. Feedback loop 2 was developing mechanisms for improved communication across the care continuum. It included (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; and (7) creation of a care coordinator role for survivors. Feedback loop 3 was learning from post-ICU outcomes to improve future care. It included (8) developing comprehensive post-ICU care pathways; (9) enhancing support for patients following a hospital stay; and (10) integration of post-ICU outcomes within the ICU to improve clinician morale and understanding.

INTERPRETATION:

Practical 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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Críticos / Unidades de Terapia Intensiva Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Revista: Chest Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cuidados Críticos / Unidades de Terapia Intensiva Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Revista: Chest Ano de publicação: 2024 Tipo de documento: Article