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Gustavson AM, Eaton TL, Schapira RM, Iwashyna TJ, Adly M, Purnell A. Approaches to long COVID care: the Veterans Health Administration experience in 2021. BMJ Mil Health 2024; 170:179-180. [PMID: 35777859 DOI: 10.1136/military-2022-002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Allison M Gustavson
- VA Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis, Minnesota, USA
- Department of Medicine, Division of General Internal Medicine, University of Minnesota System, Minneapolis, Minnesota, USA
| | - T L Eaton
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - R M Schapira
- Research Service, New Orleans VA Medical Center, New Orleans, Louisiana, USA
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - T J Iwashyna
- Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - M Adly
- Central Office, US Department of Veterans Affairs, Washington, DC, USA
- Office of the Chief Technology Officer, US Department of Veterans Affairs, Washington, DC, USA
| | - A Purnell
- Central Office, US Department of Veterans Affairs, Washington, DC, USA
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2
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Eaton TL, Lincoln TE, Lewis A, Davis BC, Sevin CM, Valley TS, Donovan HS, Seaman J, Iwashyna TJ, Alexander S, Scheunemann LP. Palliative Care in Survivors of Critical Illness: A Qualitative Study of Post-Intensive Care Unit Program Clinicians. J Palliat Med 2023; 26:1644-1653. [PMID: 37831930 PMCID: PMC10771886 DOI: 10.1089/jpm.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Survivors of critical illness experience high rates of serious health-related suffering. The delivery of palliative care may assist in decreasing this burden for survivors and their families. Objectives: To understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. Design: Qualitative inquiry using semistructured interviews and framework analysis. Results were mapped using the Consolidated Framework for Implementation Research. Setting/Subjects: We interviewed 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. Results: All interprofessional clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. Facilitators promoting palliative care strategies were clinician level, including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers were reciprocals and included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers included time constraints, cost, and lack of specialty palliative care services. Conclusion: Palliative care may be an essential element of post-ICU clinic care. Implementation efforts focused on tailoring strategies to improve post-ICU program clinicians' palliative care knowledge and self-efficacy could be a key to enhanced care delivery for survivors of critical illness.
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Affiliation(s)
- Tammy L. Eaton
- National Clinician Scholars Program (NCSP), VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
- Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Taylor E. Lincoln
- Department of Critical Care Medicine, and Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna Lewis
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Clinical Care Coordination and Discharge Planning, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Brian C. Davis
- Kline School of Law, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Carla M. Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas S. Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Heidi S. Donovan
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Seaman
- Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theodore J. Iwashyna
- Department of Medicine, Division of Pulmonary and Critical Care, School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheila Alexander
- Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, and Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leslie P. Scheunemann
- Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Eaton TL, Gersten RA, Iwashyna TJ. It Is Feasible to Relieve Distressing Symptoms after the ICU. Am J Respir Crit Care Med 2023; 208:1151-1153. [PMID: 37878817 PMCID: PMC10868363 DOI: 10.1164/rccm.202310-1768ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Tammy L Eaton
- Department of Internal Medicine Michigan Medicine Ann Arbor, Michigan
- Center for Clinical Management Research Veterans Affairs Ann Arbor Healthcare System Ann Arbor, Michigan
| | | | - Theodore J Iwashyna
- Department of Medicine Johns Hopkins University Baltimore, Maryland
- Department of Health Policy and Management Johns Hopkins University Baltimore, Maryland
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Boehm LM, Bird CM, Warren AM, Danesh V, Hosey MM, McPeake J, Potter KM, Su H, Eaton TL, Powers MB. Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery. Am J Crit Care 2023; 32:449-457. [PMID: 37907373 DOI: 10.4037/ajcc2023975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.
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Affiliation(s)
- Leanne M Boehm
- Leanne M. Boehm is an assistant professor, Vanderbilt University School of Nursing, Nashville, Tennessee; and an investigator, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claire M Bird
- Claire M. Bird is a postdoctoral fellow, Baylor University Medical Center, Dallas, Texas
| | - Ann Marie Warren
- Ann Marie Warren is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
| | - Valerie Danesh
- Valerie Danesh is a research investigator, Center for Applied Health Research, Baylor Scott & White Research Institute; and an assistant professor, Baylor College of Medicine, Temple, Texas
| | - Megan M Hosey
- Megan M. Hosey is an assistant professor, Division of Pulmonary and Critical Care Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanne McPeake
- Joanne McPeake is a research fellow, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Kelly M Potter
- Kelly M. Potter is a research assistant professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Han Su
- Han Su is an assistant professor, Vanderbilt University School of Nursing; and an investigator, CIBS Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is an associate investigator, VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Mark B Powers
- Mark B. Powers is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
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Eaton TL, Taylor SP. Health system approaches to providing posthospital care for survivors of sepsis and critical illness. Curr Opin Crit Care 2023; 29:513-518. [PMID: 37641522 DOI: 10.1097/mcc.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. RECENT FINDINGS Multiple studies conducted in the adult population over the last 18 months have advanced current knowledge on postdischarge care after sepsis and critical illness. Effective interventions are complex and multicomponent, targeting the multilevel challenges that survivors face. Health systems can leverage existing care models such as primary care or invest in specialty programs to deliver postdischarge care. Qualitative and implementation science studies provide insights into important contextual factors for program success. Several studies demonstrate successful application of telehealth to improve reach of postdischarge support. Research is beginning to identify subtypes of survivors that may respond to tailored intervention strategies. SUMMARY Several successful critical illness survivor models of care have been implemented and knowledge about effectiveness, cost, and implementation factors of these strategies is growing. Further innovation is needed in intervention development and evaluation to advance the field.
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Affiliation(s)
- Tammy L Eaton
- National Clinician Scholars Program (NCSP); VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan Department of Systems, Populations and Leadership, University of Michigan School of Nursing
| | - Stephanie Parks Taylor
- Division of Hospital Medicine, Michigan Medicine; & Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Danesh V, McDonald AD, McPeake J, Eaton TL, Potter K, Su H, Jackson JC, Boehm LM. Driving decisions after critical illness: Qualitative analysis of patient-provider reviews during ICU recovery clinic assessments. Int J Nurs Stud 2023; 146:104560. [PMID: 37531701 PMCID: PMC10528726 DOI: 10.1016/j.ijnurstu.2023.104560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Driving a vehicle is a functional task requiring a threshold of physical, behavioral and cognitive skills. OBJECTIVE To report patient-provider evaluations of driving status and driving safety assessments after critical illness. DESIGN Qualitative secondary analysis of driving-related dialog drawn from a two-arm pilot study evaluating telemedicine delivery of Intensive Care Unit Recovery Clinic assessments. Multidisciplinary providers assessed physical, psychological, and cognitive recovery during one-hour telemedicine ICU-RC assessments. Qualitative secondary analysis of patient-provider dialog specific to driving practices after critical illness. SETTING AND PATIENTS Multidisciplinary Intensive Care Unit Recovery clinic assessment dialog between 17 patients and their providers during 3-week and/or 12-week follow-up assessments at a tertiary academic medical center in the Southeastern United States. MAIN MEASURES AND KEY RESULTS Thematic content analysis was performed to describe and classify driving safety discussion, driving status and driving practices after critical illness. Driving-related discussions occurred with 15 of 17 participants and were clinician-initiated. When assessed, driving status varied with participants reporting independent decisions to resume driving, delay driving and cease driving after critical illness. Patient-reported driving practices after critical illness included modifications to limit driving to medical appointments, self-assessments of trip durations, and inclusion of care partners as a safety measure for new onset fatigue while driving. CONCLUSION We found that patients are largely self-navigating this stage of recovery, making subjective decisions on driving resumption and overall driving status. These results highlight that driving status changes are an often underrecognized yet salient social cost of critical illness. TRIAL REGISTRATION Clinicaltrials.gov: NCT03926533.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA; School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Anthony D McDonald
- College of Engineering, University of Wisconsin at Madison, Madison, WI, USA. https://twitter.com/hfml_lab
| | - Joanne McPeake
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK. https://twitter.com/Jomcpeake22
| | - Tammy L Eaton
- National Clinician Scholars Program (NCSP), VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan, Ann Arbor, MI, USA; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA. https://twitter.com/tammyeaton17
| | - Kelly Potter
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. https://twitter.com/KP_ICURN
| | - Han Su
- School of Nursing, Vanderbilt University, Nashville, TN, USA. https://twitter.com/HanSu_hs
| | - James C Jackson
- Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. https://twitter.com/jcjackson68
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA. https://twitter.com/boehmleanne
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Abstract
This cross-sectional study examines the postintensive care syndrome in patients who had vs patients who had not resumed driving 1 month after hospitalization for a critical illness.
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Affiliation(s)
- Kelly M Potter
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Health, Dallas, Texas
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tammy L Eaton
- National Clinician Scholars Program, Veterans Affairs Health Services Research and Development Service Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor
| | - Anthony D McDonald
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison
| | - Timothy D Girard
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Boehm LM, Danesh V, Eaton TL, McPeake J, Pena MA, Bonnet KR, Stollings JL, Jones AC, Schlundt DG, Sevin CM. Multidisciplinary ICU Recovery Clinic Visits: A Qualitative Analysis of Patient-Provider Dialogues. Chest 2023; 163:843-854. [PMID: 36243061 PMCID: PMC10258431 DOI: 10.1016/j.chest.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Research confirms the heterogeneous nature of patient challenges during recovery from the ICU and supports the need for modifying care experiences, but few data are available to guide clinicians seeking to support patients' individual recovery trajectories. RESEARCH QUESTION What is the content of patient-provider dialogues in a telemedicine multidisciplinary ICU recovery clinic (ICU-RC)? STUDY DESIGN AND METHODS We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the southeastern United States. The sample included 19 patients and 13 caregivers (≥ 18 years of age) attending a telemedicine ICU-RC visit after critical illness resulting from septic shock or ARDS. Patients and caregivers met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 33 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches. RESULTS Two themes were identified from the patient-provider dialogue: (1) problem identification and (2) problem-solving strategies. We identified five subthemes that capture the types of problems identified: health status, mental health and cognition, medication management, health-care access and navigation, and quality of life. Problem-solving subthemes included facilitating care coordination and transitions, providing education, and giving constructive feedback and guidance. INTERPRETATION Patients surviving a critical illness experience a complexity of problems that may be addressed best by a multidisciplinary ICU-RC. Through analysis of our telemedicine ICU-RC dialogues, we were able to identify problems and solutions to address challenges during a critical transitional phase of ICU recovery. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03926533; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN; Critical Illness, Brain Dysfunction, Survivorship Center, Nashville, TN.
| | - Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX
| | - Tammy L Eaton
- National Clinician Scholars Program, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor, MI; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, England
| | - Maria A Pena
- Department of Psychology, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN
| | - Kemberlee R Bonnet
- Department of Psychology, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN
| | - Joanna L Stollings
- Critical Illness, Brain Dysfunction, Survivorship Center, Nashville, TN; Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | | | - David G Schlundt
- Department of Psychology, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN
| | - Carla M Sevin
- Critical Illness, Brain Dysfunction, Survivorship Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Eaton TL, Lewis A, Donovan HS, Davis BC, Butcher BW, Alexander SA, Iwashyna TJ, Scheunemann LP, Seaman J. Examining the needs of survivors of critical illness through the lens of palliative care: A qualitative study of survivor experiences. Intensive Crit Care Nurs 2023; 75:103362. [PMID: 36528461 DOI: 10.1016/j.iccn.2022.103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the needs of adult survivors of critical illness through a lens of palliative care. RESEARCH METHODOLOGY A qualitative study of adult survivors of critical illness using semi-structured interviews and framework analysis. SETTING Participants were recruited from the post-intensive care unit clinic of a mid-Atlantic academic medical center in the United States. FINDINGS Seventeen survivors of critical illness aged 34-80 (median, 66) participated in the study. The majority of patients were female (64.7 %, n = 11) with a median length of index ICU stay of 12 days (interquartile range [IQR] 8-19). Interviews were conducted February to March 2021 and occurred a median of 20 months following the index intensive care stay (range, 13-33 months). We identified six key themes which align with palliative care principles: 1) persistent symptom burden; 2) critical illness as a life-altering experience; 3) spiritual changes and significance; 4) interpreting/managing the survivor experience; 5) feelings of loss and burden; and 6) social support needs. CONCLUSION Our findings suggest that palliative care components such as symptom management, goals of care discussions, care coordination, and spiritual and social support may assist in the assessment and treatment of survivors of critical illness.
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Affiliation(s)
- Tammy L Eaton
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; National Clinician Scholars Program (NCSP), Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Anna Lewis
- School of Public Health, Department of Health Policy and Management, University of Pittsburgh, PA, USA; Care Management Department, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, USA
| | - Heidi S Donovan
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA
| | - Brian C Davis
- School of Law, Duquesne University, Pittsburgh, PA, USA
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sheila A Alexander
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Leslie P Scheunemann
- Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer Seaman
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Valley TS, Schutz A, Miller J, Miles L, Lipman K, Eaton TL, Kinni H, Cooke CR, Iwashyna TJ. Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals. Intensive Care Med 2023; 49:505-516. [PMID: 36952016 PMCID: PMC10035493 DOI: 10.1007/s00134-023-07031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Some hospitals in the United States (US) use intensive care 20 times more than others. Since intensive care is lifesaving for some but potentially harmful for others, there is a need to understand factors that influence how intensive care unit (ICU) admission decisions are made. METHODS A qualitative analysis of eight US hospitals was conducted with semi-structured, one-on-one interviews supplemented by site visits and clinical observations. RESULTS A total of 87 participants (24 nurses, 52 physicians, and 11 other staff) were interviewed, and 40 h were spent observing ICU operations across the eight hospitals. Four hospital-level factors were identified that influenced ICU admission decision-making. First, availability of intermediate care led to reallocation of patients who might otherwise be sent to an ICU. Second, participants stressed the importance of ICU nurse availability as a key modifier of ICU capacity. Patients cared for by experienced general care physicians and nurses were less likely to receive ICU care. Third, smaller or rural hospitals opted for longer emergency department patient-stays over ICU admission to expedite interhospital transfer of critically ill patients. Fourth, lack of clarity in ICU admission policies led clinicians to feel pressured to use ICU care for patients who might otherwise not have received it. CONCLUSION Health care systems should evaluate their use of ICU care and establish institutional patterns that ensure ICU admission decisions are patient-centered but also account for resources and constraints particular to each hospital.
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Affiliation(s)
- Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16-G019W, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
- VA Center for Clinical Management Research, Ann Arbor, MI, USA.
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16-G019W, Ann Arbor, MI, 48109, USA
| | - Jacquelyn Miller
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16-G019W, Ann Arbor, MI, 48109, USA
| | - Lewis Miles
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Kyra Lipman
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tammy L Eaton
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program and VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Harish Kinni
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Colin R Cooke
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16-G019W, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
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Gustavson AM, Purnell A, Adly M, Awan O, Bräu N, Braus NA, Bryant MS, Chang L, Cyborski C, Darvish B, Del Piero LB, Eaton TL, Kiliveros A, Kloth H, McNiel ER, Miller MA, Patrick A, Powers P, Pyne M, Rodriguez IG, Romesser J, Rud B, Seidel I, Tepper A, Trinh H, Tonkin B, Vachachira J, Yang H, Shak JR. A Learning Health System Approach to Long COVID Care. Fed Pract 2022; 39:310-314. [PMID: 36425345 PMCID: PMC9648579 DOI: 10.12788/fp.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Global initiatives to mitigate COVID-19 transmission have shifted health system priorities to management of patients with prolonged long COVID symptoms. To better meet the needs of patients, clinicians, and systems, a learning health system approach can use rapid-cycle methods to integrate data and real-world experience to iteratively evaluate and adapt models of long COVID care. OBSERVATIONS Employees in the Veterans Health Administration formed a multidisciplinary workgroup. We sought to develop processes to learn more about this novel long COVID syndrome and innovative long COVID care models that can be applied within and outside of our health care system. We describe our workgroup processes and goals to create a mechanism for cross-facility communication, identify gaps in care and research, and cocreate knowledge on best practices for long COVID care delivery. CONCLUSIONS The learning health system approach will be critical in reimagining health care service delivery after the COVID-19 pandemic.
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Affiliation(s)
- Allison M Gustavson
- Veterans Affairs Health Care System, Minnesota
- University of Minnesota, Minneapolis
| | - Amanda Purnell
- Department of Veterans Affairs Central Office, Washington DC
| | - Marian Adly
- Department of Veterans Affairs Central Office, Washington DC
- Office of the Chief Technology Officer, Washington DC
| | - Omar Awan
- Washington DC Veterans Affairs Medical Center
| | - Norbert Bräu
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Nicholas A Braus
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Mon S Bryant
- Michael E. De- Bakey Veterans Affairs Medical Center, Houston, Texas
| | - Lynn Chang
- West Los Angeles Veterans Affairs Health Care System, California
| | | | - Babak Darvish
- West Los Angeles Veterans Affairs Health Care System, California
| | - Larissa B Del Piero
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington
- University of Washington School of Medicine, Seattle
| | | | - Amelia Kiliveros
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Heather Kloth
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Eric R McNiel
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Megan A Miller
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington
| | - Alana Patrick
- Minneapolis Veterans Affairs Health Care System, Minnesota
| | - Patrick Powers
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- University of Utah, Salt Lake City
| | - Morgan Pyne
- James A. Haley Veterans' Hospital, Tampa, Florida
| | - Idelka G Rodriguez
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Mount Sinai School of Medicine, New York, New York
| | - Jennifer Romesser
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Brittany Rud
- Minneapolis Veterans Affairs Health Care System, Minnesota
| | - Ilana Seidel
- San Francisco Veterans Affairs Medical Center, California
| | - Alexandria Tepper
- Department of Veterans Affairs Central Office, Washington DC
- Booze Allen Hamilton Inc, McLean, Virginia
| | - Hanh Trinh
- South Texas Veterans Health Care System, San Antonio
| | - Brionn Tonkin
- Minneapolis Veterans Affairs Health Care System, Minnesota
| | | | - Hlee Yang
- Geriatric Research Education and Clinical Center, Minneapolis Veterans Affairs Healthcare System, Minnesota
| | - Joshua R Shak
- San Francisco Veterans Affairs Medical Center, California
- University of California San Francisco
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Butcher BW, Eaton TL, Montgomery-Yates AA, Sevin CM. Meeting the Challenges of Establishing Intensive Care Unit Follow-up Clinics. Am J Crit Care 2022; 31:324-328. [PMID: 35773186 DOI: 10.4037/ajcc2022987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Intensive care unit follow-up clinics are becoming an increasingly widespread intervention to facilitate the physical, cognitive, psychiatric, and social rehabilitation of survivors of critical illness who have post-intensive care syndrome. Developing and sustaining intensive care unit follow-up clinics can pose significant challenges, and clinics need to be tailored to the physical, personnel, and financial resources available at a given institution. Although no standard recipe guarantees a successful intensive care unit aftercare program, emerging clinics will need to address a common set of hurdles, including securing an adequate space; assembling an invested, multidisciplinary staff; procuring the necessary financial, information technology, and physical stuff; using the proper screening tools to identify patients most likely to benefit and to accurately identify disabilities during the visit; and selling it to colleagues, hospital administrators, and the community at large.
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Affiliation(s)
- Brad W Butcher
- Brad W. Butcher is an associate professor and director of the Critical Illness Recovery Center, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tammy L Eaton
- Tammy L. Eaton is a health services researcher with the Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan and a National Clinician Scholars Program postdoctoral VA research fellow with the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Ashley A Montgomery-Yates
- Ashley A. Montgomery-Yates is an associate professor and director of the ICU Recovery Clinic, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky
| | - Carla M Sevin
- Carla M. Sevin is an associate professor, director of the Pulmonary Patient Care Center, and director of the ICU Recovery Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Scheunemann L, White JS, Prinjha S, Eaton TL, Hamm M, Girard TD, Reynolds C, Leland N, Skidmore ER. Barriers and facilitators to resuming meaningful daily activities among critical illness survivors in the UK: a qualitative content analysis. BMJ Open 2022; 12:e050592. [PMID: 35473739 PMCID: PMC9045053 DOI: 10.1136/bmjopen-2021-050592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify critical illness survivors' perceived barriers and facilitators to resuming performance of meaningful activities when transitioning from hospital to home. DESIGN Secondary content analysis of semistructured interviews about patients' experiences of intensive care (primary analysis disseminated on the patient-facing website www.healthtalk.org). Two coders characterised patient-perceived barriers and facilitators to resuming meaningful activities. To facilitate clinical application, we mapped the codes onto the Person-Task-Environment model of performance, a patient-centred rehabilitation model that characterises complex interactions among the person, task and environment when performing activities. SETTING United Kingdom, 2005-2006. PARTICIPANTS 39 adult critical illness survivors, sampled for variation among demographics and illness experiences. RESULTS Person-related barriers included negative mood or affect, perceived setbacks; weakness or limited endurance; pain or discomfort; inadequate nutrition or hydration; poor concentration/confusion; disordered sleep/hallucinations/nightmares; mistrust of people or information; and altered appearance. Task-related barriers included miscommunication and managing conflicting priorities. Environment-related barriers included non-supportive health services and policies; challenging social attitudes; incompatible patient-family coping (emotional trauma and physical disability); equipment problems; overstimulation; understimulation; and environmental inaccessibility. Person-related facilitators included motivation or attitude; experiencing progress; and religion or spirituality. Task-related facilitators included communication. Environment-related facilitators included support from family, friends or healthcare providers; supportive health services and policies; equipment; community resources; medications; and accessible housing. Barriers decreased and facilitators increased over time. Six barrier-facilitator domains dominated based on frequency and emphasis across all performance goals: mood/motivation, setbacks/progress, fatiguability/strength; mis/communication; lack/community support; lack/health services and policies. CONCLUSIONS Critical illness survivors described a comprehensive inventory of 18 barriers and 11 facilitators that align with the Person-Task-Environment model of performance. Six dominant barrier-facilitator domains seem strong targets for impactful interventions. These results verify previous knowledge and offer novel opportunities for optimising patient-centred care and reducing disability after critical illness.
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Affiliation(s)
- Leslie Scheunemann
- Division of Geriatric Medicine and Gerontology in the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine in the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S White
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Tammy L Eaton
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Critical Illness Recovery Center (CIRC), UPMC Mercy, Pittsburgh, Pennsylvania, USA
| | - Megan Hamm
- Division of General Medicine in the Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy D Girard
- Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Charles Reynolds
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Natalie Leland
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Anderko RR, Gómez H, Canna SW, Shakoory B, Angus DC, Yealy DM, Huang DT, Kellum JA, Carcillo JA, Angus DC, Barnato AE, Eaton TL, Gimbel E, Huang DT, Keener C, Kellum JA, Landis K, Pike F, Stapleton DK, Weissfeld LA, Willochell M, Wofford KA, Yealy DM, Kulstad E, Watts H, Venkat A, Hou PC, Massaro A, Parmar S, Limkakeng AT, Brewer K, Delbridge TR, Mainhart A, Chawla LS, Miner JR, Allen TL, Grissom CK, Swadron S, Conrad SA, Carlson R, LoVecchio F, Bajwa EK, Filbin MR, Parry BA, Ellender TJ, Sama AE, Fine J, Nafeei S, Terndrup T, Wojnar M, Pearl RG, Wilber ST, Sinert R, Orban DJ, Wilson JW, Ufberg JW, Albertson T, Panacek EA, Parekh S, Gunn SR, Rittenberger JS, Wadas RJ, yEdwards AR, Kelly M, Wang HE, Holmes TM, McCurdy MT, Weinert C, Harris ES, Self WH, Phillips CA, Migues RM. Sepsis with liver dysfunction and coagulopathy predicts an inflammatory pattern of macrophage activation. Intensive Care Med Exp 2022; 10:6. [PMID: 35190900 PMCID: PMC8861227 DOI: 10.1186/s40635-022-00433-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
Background Interleukin-1 receptor antagonists can reduce mortality in septic shock patients with hepatobiliary dysfunction and disseminated intravascular coagulation (HBD + DIC), an organ failure pattern with inflammatory features consistent with macrophage activation. Identification of clinical phenotypes in sepsis may allow for improved care. We aim to describe the occurrence of HBD + DIC in a contemporary cohort of patients with sepsis and determine the association of this phenotype with known macrophage activation syndrome (MAS) biomarkers and mortality. We performed a retrospective nested case–control study in adult septic shock patients with concurrent HBD + DIC and an equal number of age-matched controls, with comparative analyses of all-cause mortality and circulating biomarkers between the groups. Multiple logistic regression explored the effect of HBD + DIC on mortality and the discriminatory power of the measured biomarkers for HBD + DIC and mortality. Results Six percent of septic shock patients (n = 82/1341) had HBD + DIC, which was an independent risk factor for 90-day mortality (OR = 3.1, 95% CI 1.4–7.5, p = 0.008). Relative to sepsis controls, the HBD + DIC cohort had increased levels of 21 of the 26 biomarkers related to macrophage activation (p < 0.05). This panel was predictive of both HBD + DIC (sensitivity = 82%, specificity = 84%) and mortality (sensitivity = 92%, specificity = 90%). Conclusion The HBD + DIC phenotype identified patients with high mortality and a molecular signature resembling that of MAS. These observations suggest trials of MAS-directed therapies are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00433-y.
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15
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McPeake J, Iwashyna TJ, Boehm LM, Hibbert E, Bakhru RN, Bastin AJ, Butcher BW, Eaton TL, Harris W, Hope AA, Jackson J, Johnson A, Kloos JA, Korzick KA, Meyer J, Montgomery-Yates A, Mikkelsen ME, Slack A, Wade D, Still M, Netzer G, Hopkins RO, Quasim T, Sevin CM, Haines KJ. Benefits of Peer Support for Intensive Care Unit Survivors: Sharing Experiences, Care Debriefing, and Altruism. Am J Crit Care 2021; 30:145-149. [PMID: 33566086 DOI: 10.4037/ajcc2021702] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues. OBJECTIVE To explore what patients believed to be the key mechanisms of effectiveness of peer support programs implemented during critical care recovery. METHODS In a secondary analysis of an international qualitative data set, 66 telephone interviews with patients were undertaken across 14 sites in Australia, the United Kingdom, and the United States to understand the effect of peer support during recovery from critical illness. Prevalent themes were documented with framework analysis. RESULTS Most patients who had been involved in peer support programs reported benefit. Patients described 3 primary mechanisms: (1) sharing experiences, (2) care debriefing, and (3) altruism. CONCLUSION Peer support is a relatively simple intervention that could be implemented to support patients during recovery from critical illness. However, more research is required into how these programs can be implemented in a safe and sustainable way in clinical practice.
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Affiliation(s)
- Joanne McPeake
- Joanne McPeake is a nurse consultant, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom and an honorary senior clinical lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom, and a research fellow, THIS Institute, University of Cambridge, United Kingdom
| | - Theodore J. Iwashyna
- Theodore J. Iwashyna is a professor of internal medicine, Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor and a research scientist, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan
| | - Leanne M. Boehm
- Leanne M. Boehm is an assistant professor, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Elizabeth Hibbert
- Elizabeth Hibbert is a physiotherapist, Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Rita N. Bakhru
- Rita N. Bakhru is an assistant professor, Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anthony J. Bastin
- Anthony J. Bastin is a consultant in critical care, Department of Perioperative Medicine, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Brad W. Butcher
- Brad W. Butcher is an assistant professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC), Pennsylvania
| | - Tammy L. Eaton
- Tammy L. Eaton is a PhD candidate, University of Pittsburgh School of Nursing, and a founder of the Critical Illness Recovery Center at UPMC Mercy
| | - Wendy Harris
- Wendy Harris is a senior nurse, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Aluko A. Hope
- Aluko A. Hope is an associate professor, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - James Jackson
- James Jackson is a research professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Annie Johnson
- Annie Johnson is a nurse practitioner, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Janet A. Kloos
- Janet A. Kloos is a clinical nurse specialist, Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Ohio
| | - Karen A. Korzick
- Karen A. Korzick is codirector of critical care medicine and medical director, ICU Survivor Clinic, Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Joel Meyer
- Joel Meyer is critical care consultants, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Ashley Montgomery-Yates is an associate professor, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington
| | - Mark E. Mikkelsen
- Mark E. Mikkelsen is an associate professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Andrew Slack
- Andrew Slack is a critical care consultant, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Dorothy Wade
- Dorothy Wade is principal health psychologist, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mary Still
- Mary Still is a clinical nurse specialist in critical care, Emory University Hospital (Emory Healthcare), Atlanta, Georgia
| | - Giora Netzer
- Giora Netzer is a professor of medicine and epidemiology, Division of Pulmonary and Critical Care, University of Maryland School of Medicine, and vice president of patient experience, University of Maryland Medical Center
| | - Ramona O. Hopkins
- Ramona O. Hopkins is a senior research associate, Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah; a founding member, Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, and a professor, Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
| | - Tara Quasim
- Tara Quasim is a critical care consultant, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde and a senior clinical lecturer, University of Glasgow
| | - Carla M. Sevin
- Carla M. Sevin is an associate professor, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center
| | - Kimberley J. Haines
- Kimberley J. Haines is physiotherapy lead and senior ICU physiotherapist, Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Australia and an associate professor, Centre for Integrated Critical Care, University of Melbourne, Australia
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16
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Hope AA, Johnson AA, McPeake J, Felt H, Sevin CM, Mikkelsen ME, Iwashyna TJ, Lassen-Greene C, Haines KJ, Agarwal S, Bakhru RN, Boehm LM, Butcher BW, Drumright K, Eaton TL, Hibbert E, Hoehn KS, Hornstein D, Imperato-Shedden H, Jackson JC, Kloos JA, Lewis A, Meyer J, Montgomery-Yates A, Rojas V, Schorr C, Wade D, Williams C. Establishing a Peer Support Program for Survivors of COVID-19: A Report From the Critical and Acute Illness Recovery Organization. Am J Crit Care 2021; 30:e1-e5. [PMID: 33566061 PMCID: PMC8364567 DOI: 10.4037/ajcc2021675] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Aluko A Hope
- Aluko A. Hope is an associate professor, Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Annie Johnson
- Andrea (Annie) Johnson is a nurse practitioner, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joanne McPeake
- Joanne McPeake is a nurse consultant, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom and a research fellow, THIS Institute, University of Cambridge, United Kingdom
| | - Hali Felt
- Hali Felt is an author and critical care survivor who is working on her second book, titled Extracorporeal: A Memory of Science and Recovery. She lives in Sacramento, California
| | - Carla M Sevin
- Carla M. Sevin is an associate professor, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark E Mikkelsen
- Mark E. Mikkelsen is an associate professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Theodore J Iwashyna
- Theodore J. Iwashyna is a professor of internal medicine, Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, and a research scientist, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan
| | - Caroline Lassen-Greene
- Caroline Lassen-Greene is an assistant professor, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Kimberley J Haines
- Kimberley J. Haines is the physiotherapy lead and senior ICU physiotherapist, Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Australia and an associate professor, Centre for Integrated Critical Care, School of Medicine, The University of Melbourne, Australia
| | - Sachin Agarwal
- Sachin Agarwal is an assistant professor, Department of Neurology (Neurocritical Care), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Rita N Bakhru
- Rita N. Bakhru is an assistant professor, Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Leanne M Boehm
- Leanne M. Boehm is an assistant professor, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Brad W Butcher
- Brad W. Butcher is an assistant professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC), Pennsylvania
| | - Kelly Drumright
- Kelly Drumright is a clinical nurse leader for the medical intensive care unit, Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is a PhD candidate at the University of Pittsburgh, School of Nursing, and a founder of the Critical Illness Recovery Center (CIRC) at UPMC Mercy in Pittsburgh, Pennsyvania
| | - Elizabeth Hibbert
- Elizabeth Hibbert is a physiotherapist, Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Karen Sara Hoehn
- Karen Sara Hoehn is director of the Pediatric Palliative Care Team, University of Chicago, Illinois
| | - David Hornstein
- David Hornstein is an assistant professor, McGill University Health Centre, Program of Critical Care and Internal Medicine, Montreal, Québec, Canada
| | - Heather Imperato-Shedden
- Heather Imperato-Shedden is a social worker and family and patient support specialist, Morristown Medical Center, Morristown, New Jersey
| | - James C Jackson
- James C. Jackson is a research professor, Vanderbilt University Medical Center
| | - Janet A Kloos
- Janet A. Kloos is a clinical nurse specialist, Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Ohio
| | - Anna Lewis
- Anna Lewis is a senior social worker, CIRC, UPMC Mercy Hospital, Pittsburgh, Pennsylvania
| | - Joel Meyer
- Joel Meyer is a critical care consultant, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ashley Montgomery-Yates
- Ashley Montgomery-Yates is an associate professor, Department of Medicine, University of Kentucky
| | - Veronica Rojas
- Veronica Rojas is a critical care nurse leader, Department of Internal Medicine, Hospital Clínico Universidad de Chile, Santiago
| | - Christa Schorr
- Christa Schorr is a clinical nurse scientist and associate professor, Department of Medicine, Division of Critical Care, Cooper Medical School of Rowan University Health Care in New Jersey
| | - Dorothy Wade
- Dorothy Wade is principal health psychologist, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Cydni Williams
- Cydni Williams is an associate professor, Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health & Science University, Portland
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17
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Haines KJ, McPeake J, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, Bastin AJ, Beesley SJ, Beveridge L, Butcher BW, Drumright K, Eaton TL, Farley T, Firshman P, Fritschle A, Holdsworth C, Hope AA, Johnson A, Kenes MT, Khan BA, Kloos JA, Kross EK, Mactavish P, Meyer J, Montgomery-Yates A, Quasim T, Saft HL, Slack A, Stollings J, Weinhouse G, Whitten J, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna TJ, Sevin CM. Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives. Crit Care Med 2020; 47:1194-1200. [PMID: 31241499 DOI: 10.1097/ccm.0000000000003818] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. DESIGN Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data. SETTING Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents. SUBJECTS Clinicians from 21 sites. MEASUREMENT AND MAIN RESULTS Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising. CONCLUSIONS Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | | | | | - Rita N Bakhru
- Wake Forest University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Winston Salem, NC
| | - Anthony J Bastin
- Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sarah J Beesley
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT.,Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.,Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Lynne Beveridge
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN
| | - Tammy L Eaton
- Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, PA
| | - Thomas Farley
- School of Nursing, University of California San Francisco, San Francisco, CA
| | | | | | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | | | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Babar A Khan
- Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN
| | - Janet A Kloos
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Erin K Kross
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Pamela Mactavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Joel Meyer
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Howard L Saft
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Andrew Slack
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanna Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | - Gerald Weinhouse
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.,Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
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Eaton TL, McPeake J, Rogan J, Johnson A, Boehm LM. Caring for Survivors of Critical Illness: Current Practices and the Role of the Nurse in Intensive Care Unit Aftercare. Am J Crit Care 2019; 28:481-485. [PMID: 31676524 DOI: 10.4037/ajcc2019885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Tammy L Eaton
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery.
| | - Joanne McPeake
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
| | - Julie Rogan
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
| | - Annie Johnson
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
| | - Leanne M Boehm
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
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Haines KJ, Sevin CM, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, Bastin AJ, Beesley SJ, Butcher BW, Drumright K, Eaton TL, Farley T, Firshman P, Fritschle A, Holdsworth C, Hope AA, Johnson A, Kenes MT, Khan BA, Kloos JA, Kross EK, MacLeod-Smith BJ, Mactavish P, Meyer J, Montgomery-Yates A, Quasim T, Saft HL, Slack A, Stollings J, Weinhouse G, Whitten J, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna TJ, McPeake J. Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. Intensive Care Med 2019; 45:939-947. [PMID: 31165227 PMCID: PMC6611738 DOI: 10.1007/s00134-019-05647-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/24/2019] [Indexed: 12/27/2022]
Abstract
Objective To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs. Methods Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine’s THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data. Results Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes. Conclusions The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area. Electronic supplementary material The online version of this article (10.1007/s00134-019-05647-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Sunshine Hospital, Melbourne, Australia.
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Krishna Aparanji
- Critical Care Medicine, Springfield Clinic, Springfield, IL, USA
| | - Rita N Bakhru
- Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Anthony J Bastin
- Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sarah J Beesley
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
- Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA
| | - Tammy L Eaton
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Thomas Farley
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, New York, USA
| | - Annie Johnson
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Babar A Khan
- Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN, USA
| | - Janet A Kloos
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Erin K Kross
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | | | - Pamela Mactavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Joel Meyer
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Kentucky, USA
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK
| | - Howard L Saft
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Andrew Slack
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald Weinhouse
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Whitten
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Maryland, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
- Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK.
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Pike F, Yealy DM, Kellum JA, Huang DT, Barnato AE, Eaton TL, Angus DC, Weissfeld LA. Protocolized Care for Early Septic Shock (ProCESS) statistical analysis plan. CRIT CARE RESUSC 2013; 15:301-310. [PMID: 24289512 PMCID: PMC4081520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The Protocolized Care for Early Septic Shock study is a randomised, multicentre, prospective, three-arm, parallel-group trial of alternative resuscitation strategies for early septic shock. OBJECTIVE To state our analysis plan for trial data. METHODS Our plan is to guide data collection and analysis using pre-existing definitions and testing, with local consensus-based efforts where needed. We examine protocolised care (two experimental approaches) and compare this to usual "wild type" care. RESULTS Our plan is to address three aims (clinical efficacy, biology of illness and recovery, and costs and cost-effectiveness) and four hypotheses, and we specify rules for handling data and determining outcomes. CONCLUSION By using measures to maintain study conduct and analysis rigour, we hope to improve understanding of early septic shock resuscitation and care of patients.
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Affiliation(s)
- Francis Pike
- Department of Biostatistics, Pitt Public Health, University of Pittsburgh, Pittsburgh, Pa, United States.
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