Cook Katrina, Bartholdy Roland, Raven Monique, von Dohren Gary, Rai Sumeet, Haines Kimberley, Ramanan Mahesh
Department of Intensive Care, Caboolture Hospital, Australia.
Department of Intensive Care, Caboolture Hospital, Australia; Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia; LifeFlight Queensland, Brisbane, Australia; University of Queensland, Brisbane, Australia.
Aust Crit Care. 2020 Nov;33(6):533-537. doi: 10.1016/j.aucc.2020.03.005. Epub 2020 May 16.
Intensive care follow-up clinics (ICFCs) have been implemented internationally with the aim to address the growing number of patients living with sequalae of critical illness and intensive care. However, data on Australian intensive care follow-up practice are rare.
The primary objective was to determine the proportion of Australian intensive care units (ICUs) that offer a dedicated ICFC to ICU survivors, with the intention of improving long-term outcomes of critical illness. Secondary objectives were to identify models of ICU follow-up and barriers to the implementation of ICFCs.
A custom-designed, pilot-tested 12-question online survey was sent to the nurse unit managers and medical directors of all 167 Australian ICUs listed in the database of the Australian and New Zealand Intensive Care Society. Outcome measures included proportion of ICUs offering ICFCs, details on types of follow-up services with staffing, funding source, and reasons for not providing ICU follow-up.
One hundred seven of the 167 ICUs contacted responded to the survey. Of these, two (2%) operated a dedicated ICFC. Both ICFCs were nursing-led, with one receiving dedicated funding and the other being unfunded. Three units (3%) conducted routine outpatient follow-up by telephone; one of these services was doctor-led, and two were nurse-led. Four units (4%) were performing outpatient follow-up as part of research studies only. Among the units not operating an ICFC, the main reason given for not doing so were financial constraints (58%), followed by lack of clinical need (19%) and perceived lack of evidence (11%).
In Australia, only two ICUs operated an ICFC. Only one outpatient follow-up service received dedicated funding, and financial constraints were the main reason given for units not offering outpatient follow-up services.
国际上已设立重症监护随访诊所(ICFC),旨在应对重症疾病和重症监护后遗症患者人数不断增加的情况。然而,关于澳大利亚重症监护随访实践的数据却很少。
主要目的是确定为重症监护病房(ICU)幸存者提供专门ICFC的澳大利亚ICU的比例,以改善重症疾病的长期预后。次要目的是确定ICU随访模式以及ICFC实施的障碍。
向澳大利亚和新西兰重症监护协会数据库中列出的所有167家澳大利亚ICU的护士单元经理和医疗主任发送了一份定制设计、经过预测试的包含12个问题的在线调查问卷。结果指标包括提供ICFC的ICU比例、随访服务类型的详细信息,包括人员配备、资金来源以及不提供ICU随访的原因。
联系的167家ICU中有107家回复了调查。其中,两家(2%)运营专门的ICFC。两家ICFC均由护士主导,一家获得专项资金,另一家没有资金支持。三个单元(3%)通过电话进行常规门诊随访;其中一项服务由医生主导,两项由护士主导。四个单元(4%)仅作为研究的一部分进行门诊随访。在未运营ICFC的单元中,不这样做的主要原因是资金限制(58%),其次是缺乏临床需求(19%)和认为缺乏证据(11%)。
在澳大利亚,只有两家ICU运营ICFC。只有一项门诊随访服务获得专项资金,资金限制是各单元不提供门诊随访服务的主要原因。