New care model enhances psychological, cognitive and physical recovery of ICU survivors

About 5 million adults are admitted to medical or surgical ICUs across the United States every year. Over the past two decades, the number of patients surviving an ICU stay has increased due to better critical care therapies.

"Critical Care Recovery Center: Making the Case for an Innovative Collaborative Care Model for ICU Survivors" appears in the March issue of the American Journal of Nursing. Authors are Babar Khan, M.D., M.S., of the Regenstrief Institute, IU Center for Aging Research and IU School of Medicine; Sue Lasiter, Ph.D., R.N., of the IU School of Nursing; and Malaz Boustani, M.D., MPH, of the Regenstrief Institute, IU Center for Aging Research and IU School of Medicine.

Developed by researcher-clinicians from Regenstrief and the IU Center for Aging Research to address problems unique to ICU survivors, the Eskenazi Health Critical Care Recovery Center is an outpatient clinic with an interdisciplinary care team working closely with family caregivers as well as the ICU survivors themselves. ICU survivors are seen in the center after hospital or rehabilitation facility discharge.

"The concept for the CCRC arose from the needs of young adult ICU patients who we saw leaving the hospital with functional impairments as well as a spectrum of disorders -- memory, attention, depression, mood and anxiety -- typically not seen in other patients of similar age," said Dr. Khan, lead author of the study. He serves as medical director of the Eskenazi Health Critical Care Recovery Center.

"These ICU survivors were suffering from what is known as post-intensive care syndrome or PICS, caused in part by the treatments they received when critically ill. The survivors and their families weren't finding the help they needed for things as simple as conflicting prescriptions to major issues like severe psychosis. Before we developed the CCRC, the health care system didn't have any care delivery models specifically focused on the needs of ICU survivors."

Care in a Critical Care Recovery Center is provided through a patient and caregiver needs assessment; initial visit (diagnostic testing; history and physical exam; comprehensive cognitive, psychological and physical assessments; and medication reconciliation); and a follow-up visit (family conference involving physician, patient, caregiver, nurse and social worker to initiate a personalized care plan). With a sole focus on the many facets of post-intensive care syndrome, the Eskenazi Health Critical Care Recovery Center represents an innovative prototype that improves the ICU survivor’s quality of life and, according to Dr. Khan, may decrease post critical illness morbidity and mortality.

“Our support for ICU survivors should not end when they are discharged from the critical care areas or from the hospital," said study corresponding author Sue Lasiter, Ph.D., R.N., of the IU School of Nursing. "Patients and their caregivers prefer to partner with providers who understand their symptoms and can provide the focused care needed to reach their post-ICU recovery potential. The CCRC provides the perfect venue for that specialized, patient-centered care. Research is ongoing to discover innovative and effective ways to assist ICU survivors and their caregivers with PICS and to help ICU survivors self-manage their treatments and symptoms at home.”

The American Journal of Nursing paper concludes: "We believe that in tackling the significant burden of post critical illness physical, psychological, and cognitive morbidity, the CCRC presents a bold and innovative step to modify these PICS symptoms and to improve ICU survivors’ quality of life. In doing so, it may reduce unnecessary emergency room visits, recurrent hospitalizations, and help to control inflating health care costs. The CCRC prototype serves as a true ahead-of-the-curve example for other health care systems in the U.S. who are interested in instituting similar post-ICU clinics."