Clinical Investigations

Randomized Clinical Trial of an ICU Recovery Pilot Program for Survivors of Critical Illness*

Bloom, Sarah L. AGACNP-BC¹; Stollings, Joanna L. PharmD, FCCM^2,3; Kirkpatrick, Olivia AGACNP-BC¹; Wang, Li MS⁴; Byrne, Daniel W. MS⁴; Sevin, Carla M. MD^1,3; Semler, Matthew W. MD, MSc¹

Author Information

¹Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

²Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN.

³Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN.

⁴Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.

*See also p.1457.

Ms. Bloom and Dr. Stollings contributed equally to this work. Ms. Bloom, Dr. Stollings, Ms. Kirkpatrick, and Drs. Sevin and Semler contributed to study concept and design. Ms. Bloom, Dr. Stollings, Ms. Kirkpatrick, and Dr. Sevin acquired data. Ms. Bloom and Dr. Stollings drafted the article. Ms. Wang and Mr. Byrne performed statistical analysis. Mr. Byrne and Drs. Sevin and Semler supervised the study. Ms. Bloom, Dr. Stollings, Ms. Kirkpatrick, and Ms. Wang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Ms. Wang and Mr. Byrne conducted and are responsible for the data analysis. All authors performed analysis and interpreted the data. All authors performed the critical revision of the article for important intellectual content.

Byrne conducted and are responsible for the data analysis. All authors performed analysis and interpreted the data. All authors performed the critical revision of the article for important intellectual content.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grant from the Vanderbilt Institute for Clinical and Translational Research Learning Healthcare System Platform (UL1 TR000445 and Clinical Translational Science Award award number UL1TR002243 from National Center for Advancing Translational Sciences/National Institutes of Health).

Ms. Bloom’s and Dr. Stollings’s institutions received funding from Vanderbilt Institute for Clinical and Translational Research. Ms. Bloom, Mr. Byrne, and Dr. Semler received support for article research from the National Institutes of Health. Dr. Stollings received funding from the Society of Critical Care Medicine (SCCM) and Intermountain Health (lecture on postintensive care syndrome). Dr. Sevin’s institution received funding from SCCM. Dr. Semler’s institution received funding from National Heart Lung and Blood Institute (HL087738-09 and K12HL133117). The remaining authors have disclosed that they do not have any potential conflicts of interest. The contents are solely the responsibility of the authors and do not represent official views of the National Center for Advancing Translational Science or the National Institutes of Health.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 47(10):p 1337-1345, October 2019. | DOI: 10.1097/CCM.0000000000003909

Abstract

Objectives:

To examine the effect of an interdisciplinary ICU recovery program on process measures and clinical outcomes.

Design:

A prospective, single-center, randomized pilot trial.

Setting:

Academic, tertiary-care medical center.

Patients:

Adult patients admitted to the medical ICU for at least 48 hours with a predicted risk of 30-day same-hospital readmission of at least 15%.

Interventions:

Patients randomized to the ICU recovery program group were offered a structured 10-intervention program, including an inpatient visit by a nurse practitioner, an informational pamphlet, a 24 hours a day, 7 days a week phone number for the recovery team, and an outpatient ICU recovery clinic visit with a critical care physician, nurse practitioner, pharmacist, psychologist, and case manager. For patients randomized to the usual care group, all aspects of care were determined by treating clinicians.

Measurements and Main Results:

Among the primary analysis of enrolled patients who survived to hospital discharge, patients randomized to the ICU recovery program (n = 111) and usual care (n = 121) were similar at baseline. Patients in the ICU recovery program group received a median of two interventions compared with one intervention in the usual care group (p < 0.001). A total of 16 patients (14.4%) in the ICU recovery program group and 26 patients (21.5%) in the usual care group were readmitted to the study hospital within 30 days of discharge (p = 0.16). For these patients, the median time to readmission was 21.5 days (interquartile range, 11.5–26.2 d) in the ICU recovery program group and 7 days (interquartile range, 4–21.2 d) in the usual care group (p = 0.03). Four patients (3.6%) in the ICU recovery program and 14 patients (11.6%) in the usual care group were readmitted within 7 days of hospital discharge (p = 0.02). The composite outcome of death or readmission within 30 days of hospital discharge occurred in 20 patients (18%) in the ICU recovery program group and 36 patients (29.8%) in usual care group (p = 0.04).

Conclusions:

This randomized pilot trial found that a multidisciplinary ICU recovery program could deliver more interventions for post ICU recovery than usual care. The finding of longer time-to-readmission with an ICU recovery program should be examined in future trials.