New Research Validates Approach of UH Post-ICU Recovery Clinic and Support Group
May 14, 2023
UH Clinical Update | May 2023
What works best to help patients recuperate from a hospitalization in the intensive care unit (ICU) and adjust to what is often a new reality post-illness? Research from UH Cleveland Medical Center and the other members of the Society for Critical Care Medicine’s CAIRO (Critical and Acute Illness Recovery Organization) initiative is providing some answers. Importantly, the results of surveys and focus groups with patients and their families are validating the approach taken at UH and other CAIRO sites, including our Post-ICU Recovery Clinic for select patients and our Post-ICU Support Group to help patients navigate new issues that emerge in their lives after their time in the ICU, such as work limitations or insurance challenges.
Why it matters: Studies show that between 60 and 80 percent of patients discharged home after a critical illness hospitalization meet the criteria for Post-Intensive Care Syndrome (PICS), with impairments in physical, cognitive or mental health ranging from 25 to 50 percent in function. These may continue for years if unaddressed. Economic and social outcomes after critical illness include loss of or reduction in employment, need for government financial support and need for assistance with activities of daily living.
UH expertise: Clinical Nurse Specialist Janet Kloos, RN, PhD, APRN-CCNS, CCRN, has led the Post-ICU Clinic and Support Group for the past several years and represents UH on the CAIRO initiative. She and her critical care colleagues across the country and as far away as England and Australia have found that certain factors lead to a better outcome for ICU patients. These include:
- Family-targeted education
- Managing expectations
- Family support during rehabilitation
- Reconnecting with the ICU post-discharge with a visit or phone call
- Access to a support group
- Ongoing support across the patient’s entire recovery trajectory
These findings were published recently in the journal Critical Care Medicine.
Dr. Kloos says these results aren’t especially surprising – it’s what she and her colleagues on the post-ICU recovery team are always trying to achieve for UH patients.
“The involvement of family is as important as many of the other interventions that we're providing,” she says. “The family can help the patient get oriented to what's happening. Patients are more grounded. Many of our patients will say they felt safe when their family member was there, cheering them on, pushing them to do a little bit more. Those interventions beginning in the ICU.”
Managing expectations and setting new life goals is another critical part of the recovery process, she says.
“Sometimes you aren't the person that you were before you had a critical illness, but it doesn't have to define who you will be going forward,” she says. “Sometimes you realize there are other things in the world you want to do – a bucket list. That’s an important thing that we try to identify or have our patients identify with us.”
More research findings: The CAIRO research team has also found from interviews with ICU patients which benefits matter most to them in post-ICU care, publishing their findings in the journal Critical Care Explorations. These factors include:
- Continuity of care
- Improving symptom status
- Normalization and expectation management
- Internal and external validation of progress
- Reducing feelings of guilt and helplessness
At UH, Dr. Kloos says the Post-ICU Team’s chaplain takes direct aim at this last issue -- patients’ surprisingly common feeling that they’re somehow to blame for their illness.
“Occasionally, people feel that they did something to deserve what happened to them,” she says. “Sometimes people feel a little responsible, such as, ‘I didn't take my blood pressure medication, so I brought this on myself.’ Our chaplain has a way of taking away that sense of blame. She makes clear that God isn't like that. He doesn’t try to purposely intend for people to go through tough times, but shows that when it happens, how we can move forward.”
The UH model: The post-ICU recovery team at UH includes Dr. Kloos, advanced practice nurse provider Kehllee Popovich, MSN, ACNP-BC, a respiratory therapist, an occupational therapist, a physical therapist, a pharmacist, a social worker and a chaplain. The last two roles are relatively new additions, she says, but now the balance feels right for meeting the variety of patients’ needs that emerge.
“I think the beauty of what we provide for our patients is that we're looking at the whole person,” she says.
One key metric the team is proud of is its ability to link post-ICU patients with the other specialists they need within the UH system, while addressing their social determinants of health.
“In our first year, we assessed and referred 14 patients to medical specialists including cardiology, pulmonology, neuropsychology, psychology, ophthalmology, COVID-19, and sleep,” Dr. Kloos says. “Referrals for outpatient physical and occupational therapy were made for 12 patients based on problems found with strength, balance and endurance and problems with memory, word finding and difficulty concentrating. Additional requests related to social needs such as getting Medicaid insurance reinstated for a transplant patient, help obtaining furniture by a patient whose house caught fire, and assistance with disability forms.”
Patients are responding well to this relatively new service, she says.
“Patients described a powerful spiritual aspect of recovery such as finding new meaning in life, reflecting on their purpose and gratefulness for surviving, for caregivers and families,” she says. In all, we’re more fully meeting not only the physical, cognitive, and emotional needs but also attending to social and spiritual aspects of holistic care.”