Actionable Processes of Care for Persistent Critical Illness
Research type
Research Study
Full title
Actionable processes of care for persistent critical illness: Patient and family-centred performance measures.
IRAS ID
225003
Contact name
Nicholas Hart
Contact email
Sponsor organisation
R&D Office, Guy's and St Thomas' NHS Foundation Trust
Duration of Study in the UK
4 years, 11 months, 31 days
Research summary
Although more people survive intensive care unit (ICU) stays than in previous decades, some critically ill patients experience persistent (also termed chronic) critical illness. This is characterised by long stays in intensive care units and hospitals, ongoing problems with physical function, and wider issues such as anxiety and depression and difficulties with thinking. Family members also experience substantial emotional distress associated with ICU admission.
Although these patients make up a small proportion of ICU patients, they are expensive to care for. These patients are more likely to die, and are less likely to be able to return home after hospital.
Patients with persistent critical illness (PCI) need different care to that which they received at the beginning of their ICU stay when they were very unwell. They need rehabilitation strategies to promote return of movement as well as the ability to talk; gradual reductions in the amount of support from the breathing machine (termed ventilator weaning); management of psychological problems such as depression and anxiety; and in some cases maintaining comfort for patients who will not survive their illness.To date, strategies shown to be successful in improving quality of care in ICU (such as daily checklists of patient care activities that improve outcomes and decrease adverse event) focus on the acute stage of ICU admission. Therefore these strategies are not useful for patients with persistent critical illness.
Our research will find out what is most important to patients and their families during their critical care stay, and what care priorities are important to the staff who care for them. Our goal is to make these types of hospital stays better for patients and their families.
We will interview former ICU patients, their families, and staff caring for them. We will then carry out a consensus-building exercise to establish the overall priorities of care.
Lay summary of study results:
Our study explored what care activities are most important to patients with a prolonged intensive care stay, their family and friends, and the healthcare professionals who care for them. We prioritised which of these care activities were most important, to inform the content of a quality improvement tool for use on the ICU. This process highlighted the importance of humanised care for people who are often awake, able to be involved in their care, but not able to because of an artificial airway and a lack of inclusion from staff. This tool was used in one London ICU for 12 weeks to see if it was possible to use and acceptable to staff. It was found both possible and acceptable, and identified on average one new care activity for each patient it was used with. We plan to next explore the views of the patients and families who the tool is used with, and understand any impact the tool has on their outcomes from ICU.REC name
London - South East Research Ethics Committee
REC reference
19/LO/0328
Date of REC Opinion
28 May 2019
REC opinion
Further Information Favourable Opinion