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Improving long-term outcomes after discharge from intensive care unit

Report from a stakeholders' conference*

Needham, Dale M. MD, PhD; Davidson, Judy DNP, RN; Cohen, Henry PharmD; Hopkins, Ramona O. PhD; Weinert, Craig MD, MPH; Wunsch, Hannah MD, MSc; Zawistowski, Christine MD; Bemis-Dougherty, Anita PT, DPT; Berney, Susan C. PT, PhD; Bienvenu, O. Joseph MD, PhD; Brady, Susan L. MS; Brodsky, Martin B. PhD; Denehy, Linda PT, PhD; Elliott, Doug RN, PhD; Flatley, Carl DDS; Harabin, Andrea L. PhD; Jones, Christina RN, PhD; Louis, Deborah RN; Meltzer, Wendy JD; Muldoon, Sean R. MD, MPH, MS; Palmer, Jeffrey B. MD; Perme, Christiane PT, CCS; Robinson, Marla OTR/L, MSc, BCPR; Schmidt, David M. MD, PhD; Scruth, Elizabeth RN; Spill, Gayle R. MD; Storey, C. Porter MD; Render, Marta MD; Votto, John DO; Harvey, Maurene A. RN, MPH, FCCM

doi: 10.1097/CCM.0b013e318232da75
Clinical Investigations

Background: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge.

Objectives: To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families.

Participants: Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge.

Design: Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems.

Measurements and Main Results: Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member.

Conclusions: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

From the OACIS Group, Pulmonary and Critical Care Medicine, and Physical Medicine and Rehabilitation (DMN), Johns Hopkins University, Baltimore, MD; Nursing Excellence and Advanced Practice (JD), Scripps Mercy Hospital, San Diego, CA; Pharmacotherapy (HC), Kingsbrook Jewish Medical Center, Woodmere, NY; Medicine, Pulmonary, and Critical Care (ROH), Intermountain Medical Center, and Psychology and Neuroscience Center, Brigham Young University, Salt Lake City, UT; Pulmonary, Allergy, Critical Care, and Sleep Medicine (CW), Clinical Outcomes Research Center, University of Minnesota, Minneapolis, MN; Anesthesiology and Epidemiology (HW), Columbia University, New York, NY; Pediatrics (CZ), Mount Sinai Kravis Children's Hospital, Brooklyn, NY; Department of Practice (ABD), American Physical Therapy Association, Alexandria, VA; Physiotherapy Department (SCB), Austin Heath, Melbourne, Australia; Psychiatry and Behavioral Sciences (OJB), Johns Hopkins University, Baltimore, MD; Research (SLB), Marianjoy Rehabilitation Hospital, Roselle, IL; Physical Medicine and Rehabilitation (MBB), Johns Hopkins University, Baltimore, MD; Physiotherapy (LD), Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia; Faculty of Nursing (DE), University of Technology, Sydney, Australia; Sepsis Alliance (CF), Tampa, FL; Division of Lung Disease (ALH), National Heart, Lung, and Blood Institute, Bethesda, MD; Critical Care Rehabilitation (CJ), Whiston Hospital, Prescot, United Kingdom; Critical Care (DL), Kaiser Sunnyside Medical Center, Clackamus, OR; Illinois Citizens for Better Care (WM), Chicago, IL; Hospital Division (SRM), Kindred Healthcare, Louisville, KY; Physical Medicine and Rehabilitation (JBP), Otolaryngology, and Functional Medicine, Johns Hopkins University, Baltimore, MD; Physical Therapy (CP), The Methodist Hospital, Houston, TX; Occupational Therapy (MR), University of Chicago Medical Center, Chicago, IL; Pulmonary and Critical Care (DMS), Kaiser Sunnyside Medical Center, Clackamus, OR; Northern California Quality Department (ES), Kaiser Permanente, San Jose, CA; Cancer Rehabilitation Program (GS), Rehabilitation Institute of Chicago, Chicago, IL; American Academy of Hospice and Palliative Medicine (CPS), Boulder, CO; Inpatient Evaluation Center (MR), Veterans Affairs Medical Center–Cincinnati, and Pulmonary/Critical Care/Sleep, University of Cincinnati College of Medicine, Cincinnati, OH; Hospital for Special Care (JV), New Britain, CT; Critical Care Educator and Consultant and Past President Society of Critical Care Medicine (MAH), Lake Tahoe, NV.

* See also p. 681.

Dr. Needham has received grant support from the National Institutes of Health. Dr. Bienvenu has received funding from the National Institutes of Health. Ms. Louis is employed by Kaiser Permanente. Dr. Muldoon is employed by and has stock ownership in Kindred Healthcare. The remaining authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins