A Quality Improvement Project to Support Post-Intensive Care Unit Patients with COVID-19: Structured Telephone Support

Sabine A. J. J. op ‘t Hoog (), Anne M. Eskes, Jos A. H. van Oers, José L. Boerrigter, Meike W. J. C. Prins-Smulders, Margo Oomen, Johannes G. van der Hoeven, Hester Vermeulen and Lilian C. M. Vloet
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Sabine A. J. J. op ‘t Hoog: Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
Anne M. Eskes: Department of Surgery, Amerstam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Jos A. H. van Oers: Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
José L. Boerrigter: Department of Surgery, Amerstam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Meike W. J. C. Prins-Smulders: Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
Margo Oomen: Department of Intensive Care, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
Johannes G. van der Hoeven: Department of Intensive Care Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
Hester Vermeulen: Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, 6500 HB Nijmegen, The Netherlands
Lilian C. M. Vloet: Research Department of Emergency and Critical Care, HAN University of Applied Science, 6525 EN Nijmegen, The Netherlands

IJERPH, 2022, vol. 19, issue 15, 1-14

Abstract: Background: More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called “post-intensive care syndrome” (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their family. An additional risk of developing symptoms of PICS was feared in the absence of structural aftercare for the patient and family shortly after discharge from the hospital. The purpose of this quality improvement study was to identify PICS symptoms and to support post-intensive care patients and families in the transition from the hospital to the home. Therefore, we offered post-ICU patients and families structured telephone support (STS). Methods: This was a quality improvement study during the 2019 COVID-19 pandemic. A project team developed and implemented a tool to structure telephone calls to identify and order symptoms according to the PICS framework and to give individual support based on this information. We supported post-ICU patients diagnosed with COVID-19 pneumonia and their family caregivers within four weeks after hospital discharge. The reported findings were both quantitative and qualitative. Results: Forty-six post-ICU patients received structured telephone support and reported symptoms in at least one of the three domains of the PICS framework. More than half of the patients experienced a loss of strength or condition and fatigue. Cognitive and psychological impairments were reported less frequently. Family caregivers reported fewer impairments concerning fatigue and sleeping problems and expressed a need for a continuity of care. Based on the obtained information, the ICU nurse practitioners were able to check if individual care plans were optimal and clear and, if indicated, initiated disciplines to optimize further follow-up. Conclusions: The implementation of the STS tool gave insight in the impairments of post-ICU patients. Surprisingly, family caregivers expressed fewer impairments. Giving support early after hospital discharge in a structured way may contribute to providing guidance in the individual care plans and treatment of the early symptoms of PICS (-F).

Keywords: intensive care unit; family-centered care; nurse-led; evidence-based quality improvements; COVID-19 (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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