Evolution in care delivery within critical illness recovery programs during the COVID-19 pandemic: a qualitative study

Eaton, T. L., Sevin, C. M., Hope, A. A., Alexander, S., Iwashyna, T. J., Boehm, L. M. and McPeake, J. (2022) Evolution in care delivery within critical illness recovery programs during the COVID-19 pandemic: a qualitative study. Annals of the American Thoracic Society, 19(11), pp. 1900-1906. (doi: 10.1513/AnnalsATS.202203-255OC) (PMID:35731631)

Abstract

Rationale: There are limited data on the impact of the COVID-19 pandemic on intensive care unit (ICU) recovery clinic care delivery practices. Objectives: We sought to better understand the patient-level factors affecting ICU recovery clinic care and changing clinical thinking during the COVID-19 pandemic. We also sought to understand how the COVID-19 pandemic sparked innovation within ICU recovery clinics. Methods: A multicenter qualitative study was conducted with ICU recovery clinic interprofessional clinicians involved with the Critical and Acute Illness Recovery Organization (CAIRO) between February and March 2021. Data were collected using semi-structured interviews and were analyzed using thematic analysis. Key themes were organized in a working analytical framework. Results: Twenty-nine participants from fifteen international sites participated in the study. Participants identified three patient-level key themes which influenced care delivery in ICU recovery programs: 1) social isolation; 2) decreased emotional reserve in patients and families; and 3) substantial social care needs. Changes in ICU recovery clinic care delivery occurred at both clinician-level (e.g., growing awareness of healthcare disparities and inequities, recognition of financial effects of illness, refinement of communication skills, increased focus on reconstructing the illness narrative) and practice-level (e.g., expansion of care delivery modes, efforts to integrate social care) in response to each of the patient-level themes. Identified gaps in ICU recovery clinic care delivery during the COVID-19 pandemic included a need for multidisciplinary team members, access to care issues (e.g., digital poverty, health insurance coverage, language barriers), and altered family engagement. Conclusion: Our study demonstrated that addressing patient-level factors such as efforts to integrate social care, address financial needs, refine provider communication skills (e.g., empathic listening), and enhance focus on reconstructing the illness narrative became important priorities during the ICU recovery clinic visit during the COVID-19 pandemic. We also identified several ongoing gaps in ICU recovery clinic care delivery which highlight the need for interventions focused on the integration of social and clinic services for critical care survivors.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McPeake, Dr Jo
• Authors: Eaton, T. L., Sevin, C. M., Hope, A. A., Alexander, S., Iwashyna, T. J., Boehm, L. M., and McPeake, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Annals of the American Thoracic Society
• Publisher: American Thoracic Society
• ISSN: 2329-6933
• ISSN (Online): 2325-6621
• Published Online: 22 June 2022
• Copyright Holders: Copyright © 2022 American Thoracic Society
• First Published: First published in Annals of the American Thoracic Society 19(11): 1900-1906
• Publisher Policy: Reproduced under a Creative Commons License