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Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors

Published online by Cambridge University Press:  30 August 2019

Sophia Wang ,
Philip Hanneman ,
Chenjia Xu ,
Sujuan Gao ,
Duane Allen ,
Dmitry Golovyan ,
You Na Kheir ,
Nicole Fowler ,
Mary Austrom  and
Sikandar Khan
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Sophia Wang*
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, IU Health Neuroscience Center, 355 W. 16th St., Indianapolis, IN 46202, USA Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN 46202, USA Sandra Eskenazi Center for Brain Care Innovation, 720 Eskenazi Avenue, Eskenazi Hospital, Indianapolis, IN 46202, USA
Philip Hanneman
Affiliation:
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN 46202, USA
Chenjia Xu
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, 410 W. 10th St., HITS 3000, Indianapolis, IN 46202, USA
Sujuan Gao
Affiliation:
Department of Biostatistics, Indiana University School of Medicine, 410 W. 10th St., HITS 3000, Indianapolis, IN 46202, USA
Duane Allen
Affiliation:
Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN 46202, USA
Dmitry Golovyan
Affiliation:
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN 46202, USA
You Na Kheir
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, IU Health Neuroscience Center, 355 W. 16th St., Indianapolis, IN 46202, USA
Nicole Fowler
Affiliation:
Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN 46202, USA Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN 46202, USA Indiana University Center of Aging Research, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN 46202, USA
Mary Austrom
Affiliation:
Department of Psychiatry, Indiana University School of Medicine, IU Health Neuroscience Center, 355 W. 16th St., Indianapolis, IN 46202, USA
Sikandar Khan
Affiliation:
Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN 46202, USA Indiana University Center of Aging Research, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN 46202, USA
Malaz Boustani
Affiliation:
Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN 46202, USA Sandra Eskenazi Center for Brain Care Innovation, 720 Eskenazi Avenue, Eskenazi Hospital, Indianapolis, IN 46202, USA Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN 46202, USA Indiana University Center of Aging Research, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN 46202, USA
Babar Khan
Affiliation:
Sandra Eskenazi Center for Brain Care Innovation, 720 Eskenazi Avenue, Eskenazi Hospital, Indianapolis, IN 46202, USA Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN 46202, USA Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN 46202, USA Indiana University Center of Aging Research, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN 46202, USA
*
Correspondence should be addressed to: Sophia Wang, Department of Psychiatry, Indiana University School of Medicine, IU Health Neuroscience Center, 355 W. 16th Street, Indianapolis, IN 46202, USA. Phone: (317) 963-7288. Email: sophwang@iupui.edu.
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Abstract

Background:

As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). We describe how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI).

Methods:

The CCRC was designed using an eight-step process known as the AI Science Playbook. Patients who required mechanical ventilation or were delirious ≥48 hours during their ICU stay were enrolled in the CCRC. One hundred twenty subjects who completed baseline HABC-M CG assessments and had demographics collected were included in the analysis to identify baseline characteristics that correlated with higher HABC-M CG scores. A subset of patients and caregivers also participated in focus group interviews to describe their perceptions of PICS.

Results:

Quantitative analyses showed that the cognitive impairment was a major concern of caregivers. Focus group data also confirmed that caregivers of ICU survivors (n = 8) were more likely to perceive cognitive and mental health symptoms than ICU survivors (n = 10). Caregivers also described a need for ongoing psychoeducation about PICS, particularly cognitive and mental health symptoms, and for ongoing support from other caregivers with similar experiences.

Conclusions:

Our study demonstrated how the AI Science Playbook was used to build the first ICU survivor clinic in the United States. Caregivers of ICU survivors continue to struggle with PICS, particularly cognitive impairment, months to years after discharge. Future studies will need to examine whether the CCRC model of care can be adapted to other complex patient populations seen by health-care professionals.

Keywords

critical carePICScognitiondeliriumdepressionfrailtyagingcaregiver stress

Information

Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Special Issue 12: Issue Theme: Implementation Science , December 2020 , pp. 1409 - 1418
Copyright
© International Psychogeriatric Association 2019

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