Objective: To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs.
Methods: Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine’s THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data.
Results: Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes.
Conclusions: The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area.
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K Haines, J McPeake, L Boehm, C Sevin and Tara Quasim are currently receiving funding from SCCM to undertake this work. L Boehm is funded by NIH/NHLBI (K12 HL137943) as is T J Iwashyna National Institutes of Health (US) (K12 HL138039).
The online version of this article (https://doi.org/10.1007/s00134-019-05647-5) contains supplementary material, which is available to authorized users.
Haines, Kimberley J.; Sevin, Carla M.; Hibbert, Elizabeth; Boehm, Leanne M.; Aparanji, Krishna; Bakhru, Rita N.; Bastin, Anthony J.; Beesley, Sarah J.; Butcher, Brad W.; Drumright, Kelly; Eaton, Tammy L.; Farley, Thomas; Firshman, Penelope; Fritschle, Andrew; Holdsworth, Clare; Hope, Aluko A.; Johnson, Annie; Kenes, Michael T.; Khan, Babar A.; Kloos, Janet A.; Kross, Erin K.; MacLeod-Smith, Belinda J.; Mactavish, Pamela; Meyer, Joel; Montgomery-Yates, Ashley; Quasim, Tara; Saft, Howard L.; Slack, Andrew; Stollings, Joanna; and Weinhouse, Gerald, "Key Mechanisms by Which Post-ICU Activities Can Improve In-ICU Care: Results of the International THRIVE Collaboratives" (2019). Internal Medicine Faculty Publications. 201.