Department of Health Sciences, University of York, York, UK
Carrera de Kinesiología, Universidad del Desarrollo Facultad de Medicina Clínica Alemana, Santiago, Chile.
BMJ Open. 2021 May 11;11(5):e048392. doi: 10.1136/bmjopen-2020-048392.
To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients' future needs and care coordination.
This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed.
GP surgeries and acute National Health Service Trusts in the UK.
GPs and clinicians leading care for patients discharged from ICU.
Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU.
We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up.
The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.
确定从重症监护病房（ICU）出院的 COVID-19 患者的后续服务计划，并探讨 ICU 工作人员和全科医生（GP）对这些患者未来需求和护理协调的看法。
这是一项使用在线调查和半结构化访谈的顺序混合方法研究。访谈数据进行了归纳编码和主题分析。调查数据进行了描述性分析。
英国的 GP 诊所和急性国民保健服务信托。
负责照顾从 ICU 出院的患者的 GP 和临床医生。
从 ICU 出院后的常规随访实践、大流行期间随访的变化，以及 GP 对从 ICU 出院患者的随访和支持需求的认识。
我们获得了 170 份调查回复，并进行了 23 次访谈。超过 60%的 GP 不知道他们当地医院通常提供的随访服务，也不知道这些服务在大流行期间是否在运作。80%的 ICU 报告了某种形式的随访服务，其中 25%在大流行高峰期暂停了服务，超过一半修改了服务（通常是远程提供）。与提供随访服务相关的常见障碍主题包括资金复杂性、职权范围和专业知识，以及 ICU 和社区服务之间的沟通。出院文件被描述为糟糕且缺乏关键信息。这两个群体都提到了在社区中获得服务的困难，以及谁负责转介和随访的问题不明确。
大流行凸显了 ICU 后随访护理的连续性和复杂资金流方面的长期问题。由于 COVID-19 而住院的大量 ICU 患者突出表明，需要改进 ICU 患者的随访服务和专科医生与 GP 之间的沟通，不仅针对 COVID-19 患者，还针对所有从 ICU 出院的患者。
