Sept. 10, 2022
Every year millions of patients are admitted to intensive care units (ICUs) across the United States — many of whom experience post-ICU syndrome. The Society of Critical Care Medicine defines post-ICU syndrome as new or worsening difficulties in physical, cognitive or emotional health following critical illness that extends beyond an acute hospitalization. Given that up to 50% of these patients may go on to develop a degree of post-ICU syndrome, physicians can begin to understand the enormity of this issue.
Since the beginning of the pandemic, conversations about lingering symptoms and newly diagnosed medical conditions following acute COVID-19 illness, termed long COVID-19, have become more mainstream. Given the relative similarity of long COVID-19 and post-ICU syndrome, more-recent validation for the latter has been noted. Many health care organizations have begun to implement new practices to meet the needs of people experiencing post-ICU syndrome.
In 2016, a multidisciplinary team from various ICUs at Mayo Clinic Hospital — Rochester received a grant from the Society of Critical Care Medicine to establish a peer support group for people who have experienced critical illness. This helped launch the team's presence on Mayo Clinic Connect — Mayo Clinic's online community — with both a group page for post-ICU syndrome as well as an informative blog about more-general issues regarding critical care. These pages remain active today and serve people from around the world.
As this online support resource evolved, the team continued to develop a foundation supporting the goal of creating a post-ICU recovery program. In the late summer of 2019, the team received the Midwest Clinical Practice Committee Innovation Award, and less than two months later, Mayo Clinic saw its very first patient with post-ICU syndrome — and the Mayo Clinic ICU Recovery Program (MCIRP) was born.
"This is a carefully constructed multidisciplinary team," says Emily A. Schmitt, O.T., O.T.D., an occupational therapist at Mayo Clinic in Rochester, Minnesota. "We needed to be mindful not to let the team get too large while still meeting the diverse needs of our patients.
"We decided to include occupational therapy (OT) rather than physical therapy (PT) because OT has overlap with PT, speech therapy and mental health counselors, including topics of aerobic exercise, strengthening, home safety, return to work, cognition, swallowing, relaxation and coping. As an OT, I can touch on a wide range of topics," Schmitt explains.
"It's been a career-defining experience to build this program with my colleagues," says Annie B. Johnson, APRN, C.N.P., a critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Johnson and Schmitt developed and continue to run the program with fellow colleague Shannon L. Piche, Pharm.D., R.Ph.
Initially all patients saw the team face to face, but a mandatory adjustment prompted by the pandemic in March 2020 made the clinic's appointments fully virtual — and they continue to be delivered via video conference or teleconference today.
Virtual clinical appointments continue to meet patient needs
The MCIRP is held virtually four times a month, with seven one-hour appointments each day. The overall goal of the program is to connect patients with post-ICU syndrome to needed resources so they can achieve the most successful recovery possible. The key to success is the multidisciplinary way in which appointments are conducted.
During each one-hour appointment, a nurse practitioner, a pharmacist, and an occupational therapist or a physical therapist are conferenced in for the entire appointment. Each team member spends time speaking with the patient, completing respective evaluations including but not limited to a review of symptoms, ICU debrief, medication reconciliation and functional reconciliation.
Throughout the appointment, the team members conference with one another to develop an individualized recovery plan for each patient. These recovery plans have consisted of a wide variety of interventions, including speciality referrals for speech and language therapy, physical therapy and occupational therapy; pulmonary and cardiac rehabilitation; social work and mental health counseling; diagnostic evaluations with lab work, imaging and cardiac studies; medication adjustments and new prescriptions as needed; and consultations with services in specialties such as otolaryngology, nutrition and neurology.
Increased number of patients treated, expanding geographical reach
It was initially unknown how the virtual delivery of this program would impact the overall experience for patients as well as for the team. It didn't take long to see the many positive changes that resulted, however. One of the most significant was the number of patients being served. In the first six months of face-to-face appointments, the team saw 36 patients, compared with 117 patients in the first six months of virtual visits. Patients recovering from critical illness often express gratitude for being able to stay at home for their appointments, avoiding travel and the physical exhaustion that can accompany in-person appointments.
The team was able to expand the geographical reach of the program as well, seeing patients from three unique states during the period of face-to-face appointments and from 23 unique states with virtual appointments.
The clinic appointments are just one aspect of the MCIRP. The Mayo Clinic team also developed an interactive care plan and a remote patient monitoring program for patients with post-ICU syndrome. These programs keep patients engaged in recovery while providing the MCIRP team with critical data to help monitor patients at a distance.
"Caring for individuals as they recover from critical illness is rewarding on multiple levels. I've learned so much, and my bedside practice has been significantly transformed," says Johnson.
Now approaching the three-year point, the MCIRP is operating successfully and nearing its 600th patient served. Active expansion to create an enterprise-wide ICU recovery program is underway, bringing this critically needed care to all Mayo Clinic patients who need it.
For more information
Barrett ML, et al. Utilization of intensive care services, 2011. In: HCUP Statistical Brief #185. Agency for Healthcare Research and Quality, 2014.
Needham DM, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Critical Care Medicine. 2012;40:502.
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