Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?

To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized.
Design: International, qualitative study.
Setting: Fourteen hospitals in the United States, United Kingdom, and Australia.
Patients: We conducted 66 semi-structured interviews with a diverse group of patients, 52 of whom had used an ICU recovery program and 14 whom had not.
Interventions: None.
Measurements and Main Results: Using content analysis, prevalent themes were documented to understand what improved their outcomes. Contrasting quotes from patients who had not received certain aspects of care were used to identify perceived differential effectiveness. Successful ICU recovery programs had five key components: 1) Continuity of care; 2) Improving symptom status; 3) Normalization and expectation management; 4) Internal and external validation of progress; and 5) Reducing feelings of guilt and helplessness. The delivery of care which achieved these goals was facilitated by early involvement (even before hospital discharge), direct involvement of ICU staff, and a focus on integration across traditional disease, symptom, and social welfare needs.
Conclusions: In this multicenter study, conducted across three continents, patients identified specific and reproducible modes of benefit derived from ICU recovery programs, which could be the target of future intervention refinement.
Competing Interests: Drs. McPeake’s, Boehm’s, Hibbert’s, Bastin’s, Johnson’s, Montgomery-Yates’s, Quasim’s, Haines’s, and Sevin’s institutions received funding from the Society of Critical Care Medicine. Dr. McPeake’s, Dr. Quasim’s, and Mrs. MacTavish’s institutions received funding from the Health Foundation (United Kingdom). Drs. Boehm’s (K12 HL137943) and Hope’s institutions received funding from the American Association of Critical-Care Nurses and the National Heart, Lung, and Blood Institute. Drs. Boehm, Hope, and Jackson received support for article research from the National Institutes of Health. Dr. Iwashyna disclosed government work (K12 HL138039). The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)