Implementation of post-intensive care outpatient clinic (I-POINT) for critically ill COVID-19 survivors

Halaçlı, Burçin; Topeli, Arzu

doi:10.3906/sag-2106-306

Cited by 6 publications

(8 citation statements)

References 44 publications

(50 reference statements)

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“…[12][13][14][15][16][17][18] The current study demonstrates a mix of clinics that routinely have multiple providers see patients at the initial visits and clinics that had the initial visit consist of one provider with established processes to see other specialties. Previous clinical models also varied between having multiple specialties involved in the initial visit [14][15][16] and using "a hub and spoke model" with a core clinician and directed referrals or sequential visits from multiple specialists. 12,13,[16][17][18] About half of clinics have interdisciplinary team meetings in the current study.…”

Section: Discussionmentioning

confidence: 84%

“…Although several articles describe PASC clinics and make recommendations on how to organize them, there is very little evidence to support one clinical model over another. [12][13][14][15][16][17][18] One of the first steps in understanding and developing a clinical standard of care is gaining a better understanding of current practices. The current survey results cannot demonstrate the effectiveness of one care model over another; however, it does suggest areas that are widely shared between PASC clinics and areas in which there are substantial differences in practice.…”

Section: Discussionmentioning

confidence: 99%

“…14,[16][17][18] Finally, although most clinics use standardized assessments/outcome measures in the current study, similar to previously described models, the specific choices of tests vary widely. [12][13][14][15]17,18 Despite the fact that many areas lack consensus, there are lessons that may be of benefit to developing PASC clinics. Practices that the majority of established PASC clinics use may suggest efficacy and serve as a starting point.…”

Section: Discussionmentioning

confidence: 99%

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A survey of dedicated PASC clinics: Characteristics, barriers and spirit of collaboration

Dundumalla

Barshikar

Niehaus

et al. 2022

PM&R

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can produce prolonged multi-organ system dysfunction and a worsened quality of life, a condition known as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). In response, clinics have emerged dedicated to the treatment of individuals with PASC. Objective: To better understand the current characteristics of these clinics, the barriers they face, and the interest in collaboration between clinics. Design: A cross-sectional survey study. Participants: Clinicians working within dedicated PASC centers (N = 94) identified primarily through the Survivor Corps database of Post-COVID Care Centers. Additional clinics were found through news articles, an American Academy of Physical Medicine and Rehabilitation Database, and word of mouth. Methods: The branching logic electronic survey consisting of up to 39 questions was sent electronically to potential participants. Results: Complete survey responses were obtained from 45 clinics. There was a wide variety of different clinical models and specialties involved. The majority of clinics were homed in physical medicine and rehabilitation (40%), pulmonology (22%), and internal medicine (16%). Most clinics (73%) reported experiencing obstacles in the treatment of their patients, the most common of which included needing more established protocols (45%) and more clinical resources (24%). Most clinics (76%) also reported an interest in participating in a collaborative clinical network. Conclusion: Despite wide variability in current clinical models of PASC clinics, there are common practices such as using telemedicine, having initial visits longer than 30 minutes, involving certain specialties in the treatment team, and having the ability for follow-up. Clinicians involved with PASC clinics have a strong interest in collaboration to improve patient care and overcome clinical obstacles, the most common of which is the lack of clear treatment protocols. More research is needed to identify which clinical models lead to better patient outcomes.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A survey of dedicated PASC clinics: Characteristics, barriers and spirit of collaboration

Dundumalla

Barshikar

Niehaus

et al. 2022

PM&R

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“…A prospectively designed study that will provide higher proportion of patients tested within all-time blocks will yield more precise insight to the nature of prolonged inflammation and coagulopathy. Approximately two-thirds of the ICU survivors and 10% of COVID-19 survivors are confronted with post-intensive care syndrome and long-COVID, respectively (36). These conditions constitute serious health burden and necessitate longterm follow-up and treatment in post-intensive care outpatient clinics.…”

Section: Discussionmentioning

confidence: 99%

Persistence of Abnormal Inflammatory and Coagulation Laboratory Tests in Critically-ill COVID-19 Survivors: Case Series

Geldigitti¹,

Halaçlı²,

Er³

et al. 2021

Crit Intensive Care

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Aim: In this study, the aim was to evaluate the persistence of abnormalities in laboratory variables regarding inflammation and coagulation during the recovery process of the critically-ill COVID-19 patients. Materials and methods:Medical records of patients who were treated for COVID-19 in our intensive care unit (ICU) were examined retrospectively. Baseline characteristics and latest abnormal test result dates for lymphocyte counts, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, fibrinogen and D-dimer levels from the first day of ICU admission were noted.Results: In total, 15 patients were enrolled in the final analysis. Overall median value (Interquartile range) for the latest abnormal test result dates from the first day of ICU admission and the ratio of patients with abnormal test results after hospital discharge were 11 (7.5-17) days and 7.7% for lymphocyte count, 15 (8-20) days and 20% for LDH, 15 (10.5-40) days and 30% for CRP, 15.5 (10.3-30.3) days and 25% for ferritin, 17 (12-95.5) days and 50% for fibrinogen, and 28 (18-68.5) days and 71.4% for D-dimer. Conclusion:In critically-ill COVID-19 survivors, abnormality of laboratory tests regarding inflammation and coagulopathy persists after hospital discharge and even after 90 days after ICU admission which suggests the probability of sustained risk for multi-organ damage and thromboembolic events.

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“…PICS has been defined as a new clinical entity [ 10 ] in which intensive care unit survivors have health problems, including mental health problems, prolonged physical impairments and cognitive impairments [ 11 ]. The patients would require a follow-up by cognitive, physical and psychiatric specialists [ 12 ] as the symptoms they suffer from could persist for years [ 13 ], resulting in health and economic challenges [ 14 ]. Importantly, these physical and mental health problems can impact the lifestyle and lead, for instance, to reduced physical activity and unhealthy dietary and sleeping habits.…”

mentioning

confidence: 99%

Post-Coronavirus Disease-2019 (COVID-19): Toward a Severe Multi-Level Health Crisis?

2021

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There were already numerous challenges facing the healthcare system prior to the ongoing coronavirus disease-2019 (COVID-19) pandemic. Although we look forward to ending this pandemic, it is still expected that the healthcare system will face further challenges leading to a multi-level health crisis. Indeed, after the COVID-19 pandemic, there will still be COVID-19 active cases and those left with health problems following COVID-19 infection who will be of a particular impact. In addition, we also have the health problems that either emerged or worsened during COVID-19, especially with the reduced ability of the healthcare system to take care of many non COVID-19 patients during the COVID-19 pandemic. Such expected evolution of the situation highlights the necessity for the decision-makers to consider applying serious reforms and take quick measures to prevent a post-COVID-19 health crisis.

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Implementation of post-intensive care outpatient clinic (I-POINT) for critically ill COVID-19 survivors

Cited by 6 publications

References 44 publications

A survey of dedicated PASC clinics: Characteristics, barriers and spirit of collaboration

A survey of dedicated PASC clinics: Characteristics, barriers and spirit of collaboration

Persistence of Abnormal Inflammatory and Coagulation Laboratory Tests in Critically-ill COVID-19 Survivors: Case Series

Post-Coronavirus Disease-2019 (COVID-19): Toward a Severe Multi-Level Health Crisis?

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