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Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives*

Haines, Kimberley J. PhD, BHSc (Physiotherapy)1,2; McPeake, Joanne PhD, MSc, BN (Hons), RGN3,4; Hibbert, Elizabeth B.Physiotherapy1; Boehm, Leanne M. PhD, RN, ACNS-BC5; Aparanji, Krishna MD, CPE6; Bakhru, Rita N. MD, MS7; Bastin, Anthony J. MBBS, PhD8; Beesley, Sarah J. MD, MSc9,10,11; Beveridge, Lynne RGN3; Butcher, Brad W. MD12; Drumright, Kelly MSN, RN, CNL13; Eaton, Tammy L. MSN, RN, FNP-BC, ACHPN14; Farley, Thomas MS, ACNP15; Firshman, Penelope BSc16; Fritschle, Andrew PharmD17; Holdsworth, Clare BPhys (Hons)1; Hope, Aluko A. MD, MSCE18; Johnson, Annie APRN, ACNP-BC19; Kenes, Michael T. PharmD, BCPS, BCCCP20; Khan, Babar A. MD, MS21; Kloos, Janet A. RN, PhD, APRN-CCNS, CCRN22; Kross, Erin K. MD23; Mactavish, Pamela BSc Pharm (Hons), MSc3; Meyer, Joel BM BCh, DM16; Montgomery-Yates, Ashley MD24; Quasim, Tara MBChB, MD3; Saft, Howard L. MD, MS25; Slack, Andrew MBBS, MRCP, EDIC, MD (Res)16; Stollings, Joanna PharmD, FCCM, FCCP26; Weinhouse, Gerald MD27; Whitten, Jessica PharmD17; Netzer, Giora MD, MSCE28; Hopkins, Ramona O. PhD10,29,30; Mikkelsen, Mark E. MD, MSCE31; Iwashyna, Theodore J. MD, PhD32,33; Sevin, Carla M. MD34

doi: 10.1097/CCM.0000000000003818
Clinical Investigations

Objectives: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.

Design: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.

Setting: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents.

Subjects: Clinicians from 21 sites.

Measurement and Main Results: Ten enablers and nine barriers to implementation of “ICU follow-up clinics” were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of “peer support groups” were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.

Conclusions: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.

1Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.

2Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.

3Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom.

4School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom.

5School of Nursing, Vanderbilt University, Nashville, TN.

6Critical Care Medicine, Springfield Clinic, Springfield, IL.

7Wake Forest University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Winston Salem, NC.

8Department of Peri-operative Medicine, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom.

9Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT.

10Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.

11Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT.

12Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.

13Tennessee Valley Healthcare System VA Medical Center, Nashville, TN.

14Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, PA.

15School of Nursing, University of California San Francisco, San Francisco, CA.

16Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom.

17Department of Pharmacy, Eskenazi Health, Indianapolis, IN.

18Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY.

19CCRN Mayo Clinic, Rochester, MN.

20Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC.

21Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN.

22University Hospitals Cleveland Medical Center, Cleveland, OH.

23Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

24Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.

25Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.

26Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN.

27Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA.

28Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.

29Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT.

30Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT.

31Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

32Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI.

33Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.

34Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

*See also p. 1269.

This does not necessarily represent the views of the U.S. government or Department of Veterans Affairs.

Drs. Haines, McPeake, Boehm, and Sevin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All other authors contributed substantially to the study design, data analysis and interpretation, and the writing of the article.

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Drs. Haines’s, McPeake’s, Hibbert’s, Boehm’s, Aparanji’s, Bastin’s, Drumright’s, Holdsworth’s, Johnson’s, Kloos’s, Meyer’s, Quasim’s, Saft’s, Stollings’s, and Sevin’s institutions received funding from the Society of Critical Care Medicine (SCCM). Drs. Haines, McPeake, Boehm, and Sevin are currently receiving funding from SCCM to undertake this work, although the supporting source had no input into the design, data collection and analysis, besides approving the final article for submission for publication. Dr. Boehm’s institution received funding from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) (1K12HL137943-01) and Vanderbilt Clinical and Translational Science Award. The funding source reviewed and approved the article for submission. Drs. Boehm and Iwashyna received support for article research from the NIH. Dr. Hope’s institution received funding from NHLBI K01-HL140279, and he received funding from American Association of Critical Care Nurses. Dr. Khan’s institution received funding from the NIH. Dr. Kross’s institution received funding from the NIH and the American Lung Association. Dr. Quasim’s institution received funding from the Health Foundation. Dr. Saft received funding from Medtronic. Dr. Stollings received funding from Intermountain Health. Dr. Weinhouse received funding from UptoDate. Dr. Hopkins’s institution received funding from Intermountain Research and Medical Foundation. Dr. Iwashyna’s institution received funding from NIH K12, and he disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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