Development of formal systems of critical care follow-up is an essential expansion of critical care services.
The impact of critical illness and intensive care services extends beyond the temporal and physical confines of critical care units. With the exception of neonatalogy, however, follow-up assessment and services have traditionally been provided through primary care or targeted subspecialist referral. As patient mortality rates decrease, intensivists have recognized the need to focus on alternative, patient-centered outcomes. Models of care with collaboration between critical care and rehabilitation services have developed, recognizing the unique skills and contributions of critical care continuity. Quality of life, symptom and morbidity assessment, socioeconomic and family impact, satisfaction, and other variables have been integrated into clinical and health services research. Critical care follow-up, however, is not standard of care.
The benefit of integrating critical care services in the prehospital setting, in the form of triage, transport, and educational efforts, has been demonstrated. Establishing greater critical care follow-up is the next logical step in the care continuum. Intensivists should assist outpatient and intermediate care providers to improve patient care while simultaneously creating a crucial feedback mechanism for quality improvement and research efforts within intensive care.
From Children's Hospital Boston, Department of Anesthesia, Division of Critical Care, and Department of Medicine, Division of General Pediatrics, Coordinated Care Service, Boston, MA.