The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial

Abstract

Objectives To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care.Design A pragmatic, non-blinded, multicentre, randomised controlled trial.Setting Three UK hospitals (two teaching hospitals and one district general hospital).Participants 286 patients aged ≥18 years were recruited after discharge from intensive care between September 2006 and October 2007.Intervention Nurse led intensive care follow-up programmes versus standard care.Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed.Results 286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI −1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (−3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective.Conclusions A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients' quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.Trial registration ISRCTN 24294750

Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

“…1,[48][49][50][51][52][53]56,57 Collectively, studies have demonstrated that patients experienced improved outcomes after implementation of a critical care outreach program; following implementation, patients experienced decreased risk of readmission to the critical care unit 49 and/or shorter stays after readmission. 49,50,52,54,56 In contrast, several studies 51,53,56,58 did not show statistically significant alterations in readmission rates, hospital length of stay, patient anxiety, or hospital survival after implementation of outreach services.…”

Improving outcomes after critical illness: harder than we thought!

“…When a heterogeneous group of patients is recruited to a study, including patients with co-morbid conditions, we need to carefully consider their impact on the outcomes at question [2,3]. Pre-existing mental health problems are an important risk factor for poor QoL and for psychiatric diagnoses after critical illness and may interact with physical outcomes in ways we do not yet understand [4].…”

“…Previous research has shown that post-intensive care syndrome is complex and so perhaps review by expert physicians should be considered a key part of our multidisciplinary approach [2]. Specifically, the healthcare specialists with the most expertise at improving mental health outcomes are surely mental health specialists.…”

Evidence supports the superiority of closed ICUs for patients and families: we are not sure

“…To this end, many institutions have embraced the idea of an ICU follow-up clinic to specifically address these concerns. To date, the largest randomized controlled trial on the topic for patients cared for in closed ICU settings (Scotland) did not demonstrate improvements in outcomes [13]. We know very little about whether the post-hospital care for patients cared for in open ICUs allows for better quality of post-hospital care.…”