Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands.
Research Department of Emergency and Critical Care, HAN University of Applied Science, 6525 EN Nijmegen, The Netherlands.
Int J Environ Res Public Health. 2022 Aug 6;19(15):9689. doi: 10.3390/ijerph19159689.
More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called "post-intensive care syndrome" (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their family. An additional risk of developing symptoms of PICS was feared in the absence of structural aftercare for the patient and family shortly after discharge from the hospital. The purpose of this quality improvement study was to identify PICS symptoms and to support post-intensive care patients and families in the transition from the hospital to the home. Therefore, we offered post-ICU patients and families structured telephone support (STS).
This was a quality improvement study during the 2019 COVID-19 pandemic. A project team developed and implemented a tool to structure telephone calls to identify and order symptoms according to the PICS framework and to give individual support based on this information. We supported post-ICU patients diagnosed with COVID-19 pneumonia and their family caregivers within four weeks after hospital discharge. The reported findings were both quantitative and qualitative.
Forty-six post-ICU patients received structured telephone support and reported symptoms in at least one of the three domains of the PICS framework. More than half of the patients experienced a loss of strength or condition and fatigue. Cognitive and psychological impairments were reported less frequently. Family caregivers reported fewer impairments concerning fatigue and sleeping problems and expressed a need for a continuity of care. Based on the obtained information, the ICU nurse practitioners were able to check if individual care plans were optimal and clear and, if indicated, initiated disciplines to optimize further follow-up.
The implementation of the STS tool gave insight in the impairments of post-ICU patients. Surprisingly, family caregivers expressed fewer impairments. Giving support early after hospital discharge in a structured way may contribute to providing guidance in the individual care plans and treatment of the early symptoms of PICS (-F).
超过 50%的重症监护病房（ICU）幸存者患有持久的身体、心理社会和认知健康障碍，也称为“重症监护后综合征”（PICS）。COVID-19 大流行期间的 ICU 入院对患者及其家属来说既不确定又有压力。由于在患者出院后不久缺乏对患者和家属的结构性后续护理，人们担心会出现 PICS 症状。本质量改进研究的目的是确定 PICS 症状，并在从医院过渡到家庭时为重症监护后患者及其家属提供支持。因此，我们为 ICU 后患者及其家属提供了结构化电话支持（STS）。
这是 COVID-19 大流行期间的一项质量改进研究。一个项目团队开发并实施了一种工具，根据 PICS 框架对电话呼叫进行结构化，以识别和排序症状，并根据这些信息提供个性化支持。我们在患者出院后四周内支持 COVID-19 肺炎诊断后的 ICU 患者及其家庭照顾者。报告的结果既有定量的，也有定性的。
46 名 ICU 后患者接受了结构化电话支持，并在 PICS 框架的三个领域中的至少一个领域报告了症状。超过一半的患者出现了体力或状况下降和疲劳。认知和心理障碍的报告较少。家庭照顾者报告的疲劳和睡眠问题较少，表达了对连续性护理的需求。根据获得的信息，ICU 执业护士能够检查个人护理计划是否最佳和明确，如果需要，启动相关学科以优化进一步的随访。
STS 工具的实施使我们深入了解了 ICU 后患者的障碍。令人惊讶的是，家庭照顾者表达的障碍较少。在出院后早期以结构化的方式提供支持可能有助于为个人护理计划和 PICS 早期症状的治疗提供指导（-F）。
