University of Glasgow School of Health & Wellbeing, Glasgow, UK.
Department of Plastic Surgery & Burns, NHS Greater Glasgow & Clyde, Glasgow, UK.
Nurs Crit Care. 2024 Jul;29(4):640-645. doi: 10.1111/nicc.13087. Epub 2024 May 11.
Critical illness survival rates have improved, but patients frequently face prolonged new or worsened physical, cognitive and psychosocial impairments. These difficulties associated with critical care admission are known as post-intensive care syndrome (PICS).
The multidisciplinary Intensive care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme was developed to support patients in the recovery period from critical illness. During the COVID-19 pandemic, the psychology support offered by this service was adapted from an in-person group to individual remote review. This audit evaluated both the extent to which this input aligned with the recommended guidelines and the acceptability of this adapted delivery to this patient group, which could help guide post-pandemic psychology input to the service.
The records of 207 patients were analysed retrospectively. The nature of support offered to a sub-sample of 50 patients detailed in clinical summary letters was compared with the Faculty of Intensive Care Medicine (2019) guidelines. Telephone calls were made to gather feedback on the virtual psychology support from 10 patients.
Psychological difficulties were identified by 111 of the 207 patients who attended the virtual clinic. A total of 88 of these patients accepted referral for virtual psychology support and 67 (76%) of those patients attended. The virtual psychology support offered was found to be largely in accordance with ICU aftercare guidance and acceptable to patients. Patients found the summary letters of consultations accurate and helpful. Most patients expressed a preference for in-person support and the opportunity to meet other patients.
The adaptations to the psychology support offered by InS:PIRE during the COVID-19 pandemic were found to be largely in line with ICU aftercare psychology guidelines and were acceptable to patients. Further research is needed on future methods of delivering psychology support for this patient group.
This audit highlights issues important to patients in the post-ICU period based on individual consultations not previously possible. Patient opinion was sought on the impact of changing the delivery of post-ICU psychological support, which will help guide future improvements in the service.
危重病患者的存活率有所提高，但他们经常面临新的或恶化的身体、认知和社会心理障碍。这些与重症监护病房入院相关的困难被称为重症监护后综合征（PICS）。
多学科重症监护综合征：促进独立和重返就业（InS:PIRE）计划旨在支持重症患者的康复期。在 COVID-19 大流行期间，该服务提供的心理支持从面对面小组改为远程个人审查。这项审计评估了这种输入与推荐指南的一致性程度，以及这种适应交付方式对该患者群体的可接受性，这有助于指导该服务在大流行后的心理投入。
回顾性分析了 207 名患者的记录。通过临床总结信详细比较了对 50 名患者的支持性质，与重症监护医学学院（2019 年）指南进行了比较。对 10 名患者进行了电话调查，以收集对虚拟心理支持的反馈。
207 名参加虚拟诊所的患者中有 111 名患者确定存在心理困难。共有 88 名患者接受了虚拟心理支持的转诊，其中 67 名（76%）患者参加了。发现虚拟心理支持在很大程度上符合 ICU 康复指导，并且患者可以接受。患者认为咨询总结信准确且有帮助。大多数患者表示更倾向于面对面支持，并希望有机会与其他患者见面。
在 COVID-19 大流行期间，InS:PIRE 提供的心理支持的调整在很大程度上符合 ICU 康复后心理指南，并且患者可以接受。需要进一步研究为该患者群体提供心理支持的未来方法。
这项审计根据以前不可能进行的个别咨询，突出了重症监护后患者关注的问题。患者对改变 ICU 后心理支持的提供方式的影响发表了意见，这将有助于指导服务的未来改进。
