Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-04T17:49:40.789Z Has data issue: false hasContentIssue false
  • English
  • Français

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
...Show all authors
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.
Get access Rights & Permissions [Opens in a new window]

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
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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angus, D. C., Kelley, M. A., Schmitz, R. J., White, A., Popovich, Jr J. and Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). (2000). Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA, 284, 2762–2770. doi:10.1001/jama.284.21.2762 CrossRefGoogle ScholarPubMed
Baldwin, M. R. (2015). Measuring and predicting long-term outcomes in older survivors of critical illness. Minerva Anestesiologica, 81, 650–661.Google ScholarPubMed
Berwick, D. M., Nolan, T. W. and Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs (Millwood), 27, 759–769. doi: 10.1377/hlthaff.27.3.759.CrossRefGoogle ScholarPubMed
Boustani, M. A., Adler, C. A. and Solid, C. A. (2018). Agile implementation: a blueprint for implementing evidence-based healthcare solutions. Journal of the American Geriatrics Society, 66, 1372–1376. doi: 10.1111/jgs.15283.CrossRefGoogle ScholarPubMed
Boustani, M. A. et al. (2019). Developing the agile implementation playbook for integrating evidence-based health care services into clinical practice. Academic Medicine, 94, 556–561.CrossRefGoogle Scholar
Brummel, N. E. et al. (2014) Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation. Critical Care Medicine, 42, 369–377.CrossRefGoogle ScholarPubMed
Callahan, C. M., Bateman, D. R., Wang, S. and Boustani, M. A. (2018). State of science: bridging the science-practice gap in aging, dementia and mental health. Journal of the American Geriatrics Society, 66, S28–S35. doi: 10.1111/jgs.15320 CrossRefGoogle ScholarPubMed
Choi, J. et al. (2014) Self-reported physical symptoms in intensive care unit (ICU) survivors: pilot exploration over four months post-ICU discharge. Journal of Pain and Symptom Management 47, 257–270.CrossRefGoogle ScholarPubMed
Comini, L., Rocchi, S., Bruletti, G., Paneroni, M., Bertolotti, G. and Vitacca, M. (2016) Impact of clinical and quality of life outcomes of long-stay ICU survivors recovering from rehabilitation on caregivers’ burden. Respiratory Care 61, 405–415.CrossRefGoogle ScholarPubMed
Desai, S. V., Law, T. J. and Needham, D. M. (2011). Long-term complications of critical care. Critical Care Medicine, 39, 371–379. doi: 10.1097/CCM.0b013e3181fd66e5.CrossRefGoogle ScholarPubMed
Gibson, V. (2010). Update on NICE guidance CG83 rehabilitation after critical illness. Nursing in Critical Care, 15, 222–223.CrossRefGoogle ScholarPubMed
Hopkins, R. O., Key, C. W., Suchyta, M. R., Weaver, L. K. and Orme, J. F. , Jr. (2010). Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome. General Hospital Psychiatry, 32, 147–155. doi: 10.1016/j.genhosppsych.2009.11.003.CrossRefGoogle ScholarPubMed
Huang, M. et al. (2016) Psychiatric symptoms in acute respiratory distress syndrome survivors: a 1-year national multicenter study. Critical Care Medicine, 44, 954–965.10.1097/CCM.0000000000001621CrossRefGoogle ScholarPubMed
Jackson, J. et al. (2014) Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. The Lancet Respiratory Medicine, 2, 369–379.CrossRefGoogle ScholarPubMed
Khan, B. A., Lasiter, S. and Boustani, M. A. (2015). CE: critical care recovery center: an innovative collaborative care model for ICU survivors. American Journal of Nursing, 115, 24–31; quiz 34, 46. doi: 10.1097/01.NAJ.0000461807.42226.3e.CrossRefGoogle ScholarPubMed
Khan, S. et al. (2018). Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial. Trials, 19, 94. doi: 10.1186/s13063-018-2449-2.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O. and Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.CrossRefGoogle Scholar
Maust, D. T. et al. (2017). Distress associated with dementia-related psychosis and agitation in relation to healthcare utilization and costs. American Journal of Geriatric Psychiatry, 25, 1074–1082.CrossRefGoogle ScholarPubMed
Monahan, P. O., Alder, C. A., Khan, B. A., Stump, T. and Boustani, M. A. (2014). The Healthy Aging Brain Care (HABC) Monitor: validation of the Patient Self-Report Version of the clinical tool designed to measure and monitor cognitive, functional, and psychological health. Clinical Interventions in Aging, 9, 2123–2132. doi: 10.2147/CIA.S64140 CrossRefGoogle ScholarPubMed
Monahan, P. O. et al. (2012). Practical clinical tool to monitor dementia symptoms: the HABC-Monitor. Clinical Interventions in Aging, 7, 143–157. doi: 10.2147/CIA.S30663.CrossRefGoogle ScholarPubMed
Montero-Odasso, M. et al. (2018) Falls in cognitively impaired older adults: implications for risk assessment and prevention. Journal of the American Geriatrics Society, 66, 367–375.CrossRefGoogle ScholarPubMed
Muscedere, J. et al. (2017). The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Medicine, 43, 1105–1122. doi: 10.1007/s00134-017-4867-0.CrossRefGoogle ScholarPubMed
Needham, D. M. et al. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical Care Medicine, 40, 502–509. doi: 10.1097/CCM.0b013e318232da75.CrossRefGoogle ScholarPubMed
Pandharipande, P. P. et al. (2007). Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA: The Journal of the American Medical Association, 298, 2644–2653.CrossRefGoogle ScholarPubMed
Pisani, M. A. et al. (2009). Days of delirium are associated with 1-year mortality in an older intensive care unit population. American Journal of Respiratory and Critical Care Medicine, 180, 1092–1097.10.1164/rccm.200904-0537OCCrossRefGoogle Scholar
PROMIS . Patient-Reported Outcomes Measurement Information System. http://www.healthmeasures.net/explore-measurement-systems/promis. 2019.Google Scholar
Randolph, C. (1998). RBANS Repeatable Battery for the Assessment of Neuropsychological Status: Manual. San Antonio, TX: Psychological Corp.Google Scholar
Reitan, R. M. and Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Tucson, AZ: Neuropsychological Press.Google Scholar
Satterfield, J. M. et al. (2009). Toward a transdisciplinary model of evidence-based practice. The Milbank Quarterly, 87, 368–390. Adapted for Oxford Review (2018). The Essential Guide to Evidence-Based Practice.CrossRefGoogle Scholar
Schofield-Robinson, O. J., et al. (2018). Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev. Issue 11. Art. No.: CD012701. doi: 10.1002/14651858.CD012701.pub2.CrossRefGoogle Scholar
Schweickert, W. D. et al. (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 373, 1874–1882.CrossRefGoogle ScholarPubMed
Stoll, C. et al. (1999) Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Medicine, 25, 697–704.CrossRefGoogle ScholarPubMed
van Beusekom, I. et al. (2018). Healthcare costs of ICU survivors are higher before and after ICU admission compared to a population based control group: a descriptive study combining healthcare insurance data and data from a Dutch national quality registry. Journal of Critical Care, 44, 345–351. doi: 10.1016/j.jcrc.2017.12.005.CrossRefGoogle ScholarPubMed
Wade, D. M. et al. (2012). Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study. Critical Care, 16, R192. doi: 10.1186/cc11677.CrossRefGoogle ScholarPubMed
Wang, S. et al. (2017a). Antidepressant use and depressive symptoms in Intensive Care Unit survivors. Journal of Hospital Medicine, 12, 731–734. doi: 10.12788/jhm.2814.CrossRefGoogle Scholar
Wang, S. et al. (2017b). Critical Care Recovery Center (CCRC): can a geriatric model of care guide recovery of ICU survivors? Best Practices in Mental Health, 13, 50–60.Google Scholar
Wang, S. et al. (2019). Validation of a new clinical tool for post-intensive care syndrome. American Journal of Critical Care, 28, 10–18.CrossRefGoogle ScholarPubMed
Yesavage, J. A. et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.CrossRefGoogle Scholar
Supplementary material: File

Wang et al. supplementary material

Figure S1

Download Wang et al. supplementary material(File)
File 221.2 KB