Introduction of an ITU outreach and follow-up service at Mater Dei Hospital

Abstract

BACKGROUND: Recently, critical illness is seen more as a continuum of care across the whole hospital stay rather than focussed solely on the ITU admission. Hospital services such as Outreach Teams, Transition Programs and Follow-up Clinics have been introduced worldwide. They focus on specific aspects of patient care such as early recognition of critical illness and rehabilitation goals. The latter is dealing mostly with the Post Intensive Care syndrome (PICS), a hereditary and complex state related specifically to ITU survivors. Mater Dei Hospital has recently launched an ITU Outreach and Follow-up Service. We analysed their data collected over one year.

METHODS: A mobile phone application “ITU Flow” was designed on a Microsoft@ Power Platform. We collected data related to the referral and discharge process. The application works as an essential auditing and communication tool of the service.

RESULTS: Patients followed-up were mostly surgical or those suffering from respiratory failure and required only one review by the ITU team. Most issues dealt with were related to the chest, weakness or drug prescription and stayed long term. The Emergency Department made most referrals concerning patients with respiratory and/or cardiovascular failure. Almost 40% of patients were immediately admitted to ITU and in one fifth of cases significant changes to patient care had to be made. Only 12% were deemed unsuitable for ITU, a very small number was admitted at a later stage.

CONCLUSION: ITU survivors appear to suffer from PICS at least in the short term, and possibly in the long term as well, as demonstrated by repeated visits after ITU discharge. This warrants individualised and interdisciplinary care. An ITU follow-up clinic in an Outpatient setting should be considered. Pre-selection of patients is essential to run the service cost efficient. Most ITU referrals lead to an admission or to major changes to the treatment plan. The Outreach Team thus contributes significantly to patient care outside ITU or assists in immediate transfer if necessary.