NeuroRecovery: Understanding the Landscape of Post-NeuroICU Clinics
Published on: November 01, 2023
Post-intensive care clinics following admission to the intensive care unit (ICU) have gained significant traction in recent years across the United States and internationally. This movement has been driven by increasing recognition of the long-term sequelae related to the experience of an ICU admission. These health impacts, termed post intensive care syndrome (PICS) and post intensive care syndrome -family (PICS-F), respectively, include cognitive impairment, psychiatric symptoms, and physical impairments.1 Severe acute brain injury (SABI) typically occurs precipitously and unexpectedly, placing patients and caregivers of these patients in particularly stressful situations because of this timing and due to the frequent lack of clear prognosis. These, and other, unique features of brain injured patients may predispose them to PICS at a greater rate than those of the medical ICU population, although this has not been systematically studied and remains controversial.2,3
Post-intensive care clinics function to improve coordination of care in a healthcare system that is often fragmented.4 Given that ICU patients may have widely diverse recovery trajectories and complex patterns of healthcare usage and morbidity following ICU discharge, the primary care physician may not have the best vantage point from which to care for their needs.5 These complications and outcomes may directly relate to their ICU care as opposed to the primary disease process. Multiple studies in the medical ICU population have demonstrated that patients' post-hospitalization needs are not being met by the current standard follow up processes. Despite recommendations, unmet needs are common.6 One recent retrospective study found that only 11% (20/189) of sepsis survivors had all four major elements of care (medication optimization, screening for common impairments post-sepsis, anticipation/monitoring for causes of deterioration, and treatment/goal alignment) addressed within 90 days of discharge. Delivery of just two or more of these care elements is associated with lower odds of 90-day readmission and mortality.6,7 Clearly, there is a role for specialized ICU follow up clinics in filling these gaps.
To date there are very few known or advertised post-neuroICU/NeuroRecovery clinics. In a recent Google search for post-neuroICU clinics only four were identified, although an additional three are known of through professional connections. We have developed a survey study to explore the true landscape of post-neuroICU/NeuroRecovery clinics in the U.S. and internationally. The study aims to learn more about the types of post-neuroICU clinics that currently exist as well as the impetus for their development and continuation. To explore the complete landscape, we also want to know the reasons why members of the neurocritical care community are not currently engaged in ICU-specific follow up clinics and their potential interest. Through this survey study we hope this information will eventually be used to improve utilization of this type of post-acute care and long-term outcomes for our neurocritical care survivors.
If you care for patients in a NeuroICU setting, please consider participating in this survey. We are seeking opinions from physicians, advanced practice providers, nurses, pharmacists, and other allied staff. We want to hear from you even if you do not work with a Post-NeuroICU/NeuroRecovery Clinic. Please follow the link to our anonymous REDCap survey: https://redcap.hhchealth.org/surveys/?s=4KMPMJMK8C48HC7J. The study will remain open for participation until December 1, 2023.
Author Institutions
1. Matthew Jaffa, DO - Division of Neurocritical Care, Department of Neurology, Ayer Neuroscience Institute, Hartford Hospital
2. Julia Carlson, MD - Division of Critical Care Neurology, University of North Carolina School of Medicine
References
1. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Crit Care Med. 2012;40(2). doi:10.1097/CCM.0b013e318232da75
2. LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-intensive care syndrome: Unique challenges in the neurointensive care unit. Neurocrit Care. 2019;31(3):534-545. doi:10.1007/s12028-019-00826-0.
3. Hwang DY. Is post-neurointensive care syndrome actually a thing? Neurocrit Care. 2019;31:453-454. doi:10.1007/s12028-019-00827-z.
4. Kuehn BM. Clinics Aim to Improve Post-ICU Recovery. JAMA - Journal of the American Medical Association. 2019;321(11). doi:10.1001/jama.2019.0420
5. Herridge MS, Chu LM, Matte A, et al. The RECOVER program: Disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Am J Respir Crit Care Med. 2016;194(7). doi:10.1164/rccm.201512-2343OC
6. Brown SM, Dinglas VD, Akhlaghi N, et al. Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study. Crit Care. 2022;26(1). doi:10.1186/s13054-021-03848-3
7. Taylor SP, Chou SH, Sierra MF, et al. Association between adherence to recommended care and outcomes for adult survivors of sepsis. Ann Am Thorac Soc. 2020;17(1). doi:10.1513/AnnalsATS.201907-514OC