Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
Department of Physiotherapy, Western Health, Footscray, Victoria, Australia.
Thorax. 2023 Dec;78(12):1181-1187. doi: 10.1136/thorax-2023-220387. Epub 2023 Aug 24.
To explore the gaps in care provided across the transitions from the intensive care unit (ICU) to primary care, in order to improve post-ICU care.
Semistructured interviews with three participant groups: intensivists, general practitioners (GPs) and patients and carers with framework analysis of textual data were used to investigate experiences of transitions of care post-ICU. Participants were purposively sampled for diversity. Eligible patients were adults, mechanically ventilated for >24 hours, with access to a video-enabled device. Exclusion criteria were non-English speaking and any cognitive/neurological limitation precluding interview participation.
A total of 46 interviews (15 patients, 8 caregivers, 15 intensivists and 8 GPs) were completed. Eight themes were identified, and categorised into three healthcare tiers. : (1) fragmentation of care; (2) communication gaps; (3) limited awareness and recognition of issues beyond the ICU; (4) lack of a specialised ICU follow-up pathway; : (5) relationships among ICU, hospitals, GPs and patients and carers; (6) need for clinician role definition and clarity in ICU follow-up; : (7) patient autonomy and self-actualisation and (8) the evolving caregiver role. A conceptual model was developed, highlighting bidirectional feedback loops between hospital and primary care.
This study identified gaps in care between ICU discharge and reintegration with primary care from the lived experience of patients, caregivers, intensivists and GPs. These data provide foci for future interventional research to improve the integration of care for this vulnerable and underserved cohort.
探讨从重症监护病房（ICU）到初级保健的过渡过程中护理的差距，以改善 ICU 后的护理。
采用半结构式访谈，对三组参与者进行访谈：重症监护医师、全科医生（GP）和患者及护理人员，并对文本数据进行框架分析，以调查 ICU 后护理过渡的经验。参与者是根据多样性进行有目的抽样的。合格的患者为成人，机械通气>24 小时，可使用视频设备。排除标准为非英语使用者和任何认知/神经限制妨碍访谈参与。
共完成 46 次访谈（15 名患者、8 名护理人员、15 名重症监护医师和 8 名全科医生）。确定了 8 个主题，并分为三个医疗保健层次。（1）护理碎片化；（2）沟通差距；（3）对 ICU 以外问题的认识和认识有限；（4）缺乏专门的 ICU 随访途径；（5）ICU、医院、GP 和患者及护理人员之间的关系；（6）需要明确界定临床医生的角色和 ICU 随访的明确性；（7）患者的自主性和自我实现；（8）护理人员角色的演变。开发了一个概念模型，突出了医院和初级保健之间的双向反馈循环。
这项研究从患者、护理人员、重症监护医师和全科医生的亲身体验中确定了 ICU 出院后与初级保健重新融合过程中护理的差距。这些数据为未来改善这一脆弱和服务不足群体的护理整合的干预性研究提供了重点。
