lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed and are posted here as part of a 12-month trial. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

Key Mechanisms by Which Post-ICU Activities Can Improve In-ICU Care: Results of the International Thrive Collaborative

30 Pages Posted: 15 Jan 2019

See all articles by Kimberley J. Haines

Kimberley J. Haines

Monash University

Carla M. Sevin

Vanderbilt University - Medical Center

Elizabeth Hibbert

Western Health

Leanne M. Boehm

Vanderbilt University

Krishna Aparanji

Springfield Clinic

Rita N Bakhru

Wake Forest University - School of Medicine

Anthony J Bastin

Government of the United Kingdom - Barts Health NHS Trust

Sarah J Beesley

University of Utah

Brad W Butcher

University of Pittsburgh - University of Pittsburgh Medical Center (UPMC)

Kelly Drumright

Tennessee Valley Healthcare System VA Medical Center

Tammy L Eaton

University of Pittsburgh - University of Pittsburgh Medical Center (UPMC)

Thomas Farley

University of California, San Francisco (UCSF)

Penelope Firshman

Guy's and St Thomas' NHS Foundation Trust

Andrew Fritschle

Eskenazi Health

Clare Holdsworth

Western Health

Aluko A Hope

Yeshiva University

Annie Johnson

Mayo Clinic

Michael T. Kenes

Wake Forest University, School of Medicine, Baptist Medical Center

Babar A. Khan

Indiana University - School of Medicine

Janet A. Kloos

Case Western Reserve University - University Hospitals Cleveland Medical Center

Erin K. Kross

University of Washington

Belinda J. MacLeod-Smith

Western Health

Pamela Mactavish

Government of the United Kingdom - NHS Greater Glasgow and Clyde

Joel Meyer

Guy's and St Thomas' NHS Foundation Trust

Ashley Montgomery-Yates

University of Kentucky

Tara Quasim

Government of the United Kingdom - NHS Greater Glasgow and Clyde

Howard L. Saft

National Jewish Health

Andrew Slack

Guy's and St Thomas' NHS Foundation Trust

Joanna Stollings

Vanderbilt University - Medical Center

Gerald Weinhouse

Harvard University - Brigham and Women's Hospital

Jessica Whitten

Eskenazi Health

Giora Netzer

University of Maryland - School of Medicine

Ramona O Hopkins

Brigham Young University

Mark E Mikkelsen

University of Pennsylvania - Hospital of the University of Pennsylvania

Theodore J Iwashyna

University of Michigan at Ann Arbor

Joanne McPeake

Government of the United Kingdom - Glasgow Royal Infirmary

More...

Abstract

Objective: Identify the key mechanisms which 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 collaboratives from over 20 centres in the UK, Australia and US (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 testing of whether these mechanisms drive improvements in patient and family-centered care, and whether these programs enhance clinician well-being and ICU culture, is warranted.

Funding Statement: 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 (K12 HL138039).

Declaration of Interests: : 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 (K12 HL138039). No conflicts of interest declared by other authors.

Ethics Approval Statement: The institutional ethics committee of the principal investigator (KH) approved the study (HREC/17/WH/170) and consent was implied through participation.

Keywords: post-intensive care syndrome, intensive care unit follow-up clinics, peer support

Suggested Citation

Haines, Kimberley J. and Sevin, Carla M. and Hibbert, Elizabeth and Boehm, Leanne M. and Aparanji, Krishna and Bakhru, Rita N and Bastin, Anthony J and Beesley, Sarah J and Butcher, Brad W and Drumright, Kelly and Eaton, Tammy L and Farley, Thomas and Firshman, Penelope and Fritschle, Andrew and Holdsworth, Clare and Hope, Aluko A and Johnson, Annie and Kenes, Michael T. and Khan, Babar A. and Kloos, Janet A. and Kross, Erin K. and MacLeod-Smith, Belinda J. and Mactavish, Pamela and Meyer, Joel and Montgomery-Yates, Ashley and Quasim, Tara and Saft, Howard L. and Slack, Andrew and Stollings, Joanna and Weinhouse, Gerald and Whitten, Jessica and Netzer, Giora and Hopkins, Ramona O and Mikkelsen, Mark E and Iwashyna, Theodore J and McPeake, Joanne, Key Mechanisms by Which Post-ICU Activities Can Improve In-ICU Care: Results of the International Thrive Collaborative (June 1, 2019). Available at SSRN: https://ssrn.com/abstract=3311873

Kimberley J. Haines

Monash University

23 Innovation Walk
Wellington Road
Clayton, Victoria 3800
Australia

Carla M. Sevin

Vanderbilt University - Medical Center

1211 Medical Center Dr
Nashville, TN 37232
United States

Elizabeth Hibbert

Western Health

Melbourne
Australia

Leanne M. Boehm

Vanderbilt University

2301 Vanderbilt Place
Nashville, TN 37240
United States

Krishna Aparanji

Springfield Clinic

Springfield, IL
United States

Rita N Bakhru

Wake Forest University - School of Medicine

Medical Center Boulevard
Winston-Salem, NC 27157-1063
United States

Anthony J Bastin

Government of the United Kingdom - Barts Health NHS Trust

London, E1 1BB
United Kingdom

Sarah J Beesley

University of Utah

1645 E. Campus Center
Salt Lake City, UT 84112
United States

Brad W Butcher

University of Pittsburgh - University of Pittsburgh Medical Center (UPMC)

Pittsburgh, PA
United States

Kelly Drumright

Tennessee Valley Healthcare System VA Medical Center

Nashville, TN
United States

Tammy L Eaton

University of Pittsburgh - University of Pittsburgh Medical Center (UPMC)

Pittsburgh, PA
United States

Thomas Farley

University of California, San Francisco (UCSF)

Third Avenue and Parnassus
San Francisco, CA 94143
United States

Penelope Firshman

Guy's and St Thomas' NHS Foundation Trust

United Kingdom

Andrew Fritschle

Eskenazi Health

720 Eskenazi Ave
Indianapolis, ID
United States

Clare Holdsworth

Western Health

Melbourne
Australia

Aluko A Hope

Yeshiva University

500 West 185th Street
New York, NY 10033
United States

Annie Johnson

Mayo Clinic

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Michael T. Kenes

Wake Forest University, School of Medicine, Baptist Medical Center

Winston-Salem, NC
United States

Babar A. Khan

Indiana University - School of Medicine

340 W 10th St #6200
Indianapolis, IN 46202
United States

Janet A. Kloos

Case Western Reserve University - University Hospitals Cleveland Medical Center

Cleveland, OH
United States

Erin K. Kross

University of Washington

Seattle, WA 98195
United States

Belinda J. MacLeod-Smith

Western Health

Melbourne
Australia

Pamela Mactavish

Government of the United Kingdom - NHS Greater Glasgow and Clyde

1055 Great Western Rd
Glasgow, G12 0XH
United Kingdom

Joel Meyer

Guy's and St Thomas' NHS Foundation Trust

United Kingdom

Ashley Montgomery-Yates

University of Kentucky

Lexington, KY 40506
United States

Tara Quasim

Government of the United Kingdom - NHS Greater Glasgow and Clyde

1055 Great Western Rd
Glasgow, G12 0XH
United Kingdom

Howard L. Saft

National Jewish Health

1400 Jackson Street
Denver, CO 80206
United States

Andrew Slack

Guy's and St Thomas' NHS Foundation Trust

United Kingdom

Joanna Stollings

Vanderbilt University - Medical Center

1211 Medical Center Dr
Nashville, TN 37232
United States

Gerald Weinhouse

Harvard University - Brigham and Women's Hospital

75 Francis St.
Boston, MA 02115
United States

Jessica Whitten

Eskenazi Health

720 Eskenazi Ave
Indianapolis, ID
United States

Giora Netzer

University of Maryland - School of Medicine

655 West Baltimore Street
College Park, MD 20742
United States

Ramona O Hopkins

Brigham Young University

Provo, UT 84602
United States

Mark E Mikkelsen

University of Pennsylvania - Hospital of the University of Pennsylvania

Philadelphia, PA
United States

Theodore J Iwashyna

University of Michigan at Ann Arbor

500 S. State Street
Ann Arbor, MI 48109
United States

Joanne McPeake (Contact Author)

Government of the United Kingdom - Glasgow Royal Infirmary ( email )

Glasgow
United Kingdom

Click here to go to TheLancet.com

Go to TheLancet.com

Paper statistics

Abstract Views
61
Downloads
10