Creating a Rehabilitation after Critical Illness pathway A novel

Creating a Rehabilitation after Critical Illness pathway A novel way of ‘funding’ an ICU follow-up service? Helen Sanger MSc. BSc. Advanced Physiotherapist in Rehabilitation after Critical Illness

Impact of critical illness Kress JP & Hall JB N Engl J Med 2014;370:1626-35 Lee et al Crit Care Med 2016;44:2270-74 Pandharipande et al N Engl J Med 2013;369:1306-16 Schellekens et al Critical Care 2016;20:103 Sonneville et al Annals of Intensive Care 2013;3:15

Impact of critical illness Hodgson et al. Intensive Care Med 2017;43:992–1001 DOI 10.1007/s00134-017-4830-0

Physiotherapy Associate Practitioner Independent ERAS caseload 7 days/week with overlap Increase rehab input with long stay patients

Change in team structure

Developing a RaCI pathway Critical care Hospital ward After hospital

RaCI outreach round Physiotherapist and CCOT nurse RaCI MDT Clinic Physiotherapist, ACCP CCOT nurse/Intensivist Goal setting ‘RaCI’ manual Psychological screening/triage Onward referrals as required Support ward therapists Discuss critical care experience Review persistent problems/ask about new ones Physical activity advice Onward referrals Liaise with GP

Critical care

Hospital ward

After hospital

11.3% Surgical admissions: 30 25 20 15 10 5 Surgical LOS : 9.3% Average MRMI score of surgical patients on discharge from ICCU 0 Pre PAP With PAP Initial rehab assessments completed within 24 hours of admission Pre-PAP With PAP “Improved MDT communication with increased continuity of senior physio staff.” “Excellent service. Delighted to see more input (particularly from physios who understand ICU patients).”

It’s not as simple as that Healt h Specialis ed Disabil ity Complicatio ns Frailt y Traum a LTC Canc er ICU Adm Surger y Electiv e Non-Cancer FollowUp ICU D/C Survivorsh ip Acute Illness Emergen cy Communi ty Rehabilitati on Hosp D/C En h Re anc e co ve d ry Multimorbidity Inpatie nt Hom e Disabil ity Readmissio n EOL Designed by Gareth Cornell, 2018

You are here

Thank you!