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.
Int Psychogeriatr. 2020 Dec;32(12):1409-1418. doi: 10.1017/S1041610219000553. Epub 2019 Aug 30.
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).
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.
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.
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.
多达 70%的重症监护病房（ICU）幸存者患有长期的身体、认知和心理障碍，称为重症监护后综合征（PICS）。我们描述了美国第一家 ICU 幸存者诊所——重症监护康复中心（CCRC）如何使用敏捷实施（AI）原则来解决 PICS。
CCRC 的设计采用了一个称为 AI 科学剧本的八步过程。在 ICU 住院期间需要机械通气或谵妄≥48 小时的患者被纳入 CCRC。有 120 名患者完成了基线 HABC-M CG 评估并收集了人口统计学数据，包括在内，以确定与更高的 HABC-M CG 分数相关的基线特征。一小部分患者和护理人员还参加了焦点小组访谈，以描述他们对 PICS 的看法。
定量分析表明，认知障碍是护理人员的主要关注点。焦点小组数据还证实，与 ICU 幸存者（n=10）相比，ICU 幸存者的护理人员（n=8）更有可能感知到认知和心理健康症状。护理人员还描述了对 PICS，特别是认知和心理健康症状进行持续心理教育的需求，以及对具有类似经历的其他护理人员的持续支持。
我们的研究表明，AI 科学剧本如何用于在美国建立第一家 ICU 幸存者诊所。ICU 幸存者的护理人员在出院后数月至数年仍继续与 PICS 作斗争，特别是认知障碍。未来的研究将需要研究 CCRC 护理模式是否可以适应其他由医疗保健专业人员治疗的复杂患者群体。
