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Interdisciplinary care center helps ICU survivors recover

The nation’s first collaborative care center, The Critical Care Recovery Center, focuses on the cognitive, physical and psychological recovery of ICU survivors, as well as decreasing the likelihood of serious illness after discharge, according to a recently published study.

“The [Critical Care Recovery Center] prototype stands as an ahead-of-the-curve example for other U.S. health care systems that might be interested in instituting an ICU aftercare clinic,” Babar A. Khan, MD, Regenstrief Institute investigator, assistant professor at the Indiana University School of Medicine, Indianapolis, and colleagues wrote.

Before developing the Critical Care Recovery Center (CCRC), Khan and colleagues studied patients who were admitted to Wishard Health Services medical-surgical ICU between May 2009 and May 2010. They found that a large portion of ICU survivors had died or were admitted to the hospital a second time, prompting motivation to address postintensive care syndrome – which includes critical neuromyopathy, depression, anxiety, PTSD and/or cognitive impairment.

The CCRC uses two patient assessments, an initial phase and a follow-up phase, to assess the needs and care plan, as well as make any necessary changes to the care of ICU survivors. Initial assessments include diagnostic testing, physical exams, inclusive cognitive, physical and psychological assessments and medication reconciliation. Follow-up visits include a family session to formulate a personalized care plan with the physician, caregiver, nurse and social worker.   

Khan and colleagues said the CCRC has four key goals with respect to patient care:

• maximize full cognitive, physical and psychological recovery following hospitalization for a critical illness;
• to enhance patient and caregiver satisfaction;
• to improve the quality of transitional and rehabilitative care; and
• to reduce unnecessary re-hospitalizations and ED visits.

Between July 2011 and May 2012, 53 patients, with an average age of 56.6 years, were seen at the CCRC. Patients were initially assessed 3 months after discharge, and were evaluated using the Healthy Aging Brain Center Monitor (HABC-M) tool. At follow-up, on average 2.5 months later, HABC-M scores showed improvement in all but one domain, the behavioral-psychological domain. Overall, the average total HABC-M scores decreased from 19.21 points at baseline to 14.75 points at the second visit.  

“If the health care community fails to develop timely and adequate means of treatment and support for ICU survivors, these patients may resort to seeking help in EDs, leading to hospital admissions that further strain the health care system. Novel interdisciplinary care models that can be rapidly translated into clinical practices are urgently needed,” Khan and colleagues wrote. – by Casey Hower

Disclosure:  Khan reports receiving support from a career development award from the National Institute on Aging. Please see the full study for a list of all other authors’ relevant financial disclosures.