Alive but not Living Georgina Linstead Kate Shaw

“Alive but not Living” Georgina Linstead, Kate Shaw & Frances Clark

Cost of critical illness � Physical � Psychological � NICE

Physical cost � Atrophy � CIPN � Joint dysfunction � Reduced functional status

Psychological cost of critical illness � Depression -17% to 43% PTSD - 21% to 35% Nonspecific anxiety - 23% to 48%. � Psychiatrist-diagnosed PTSD prevalence at hospital discharge, 5 years, and 8 years were 44%, 25%, and 24%, respectively

NICE guidance

The recommendations cover the following areas: Key principle of care During the critical care stay During ward-based care Before discharge to home or community care 2– 3 months after discharge from critical care Information Before discharge from critical care

Frimley’s experience

Early rehab & rehab pathway � Early mobilisation and physical rehabilitation � Time Garden � Quality – sleep/ clothes/ ‘This is me’

Sedation and delirium � RASS � CAM-ICU � Sedation management

Evidence � Evidence surrounding use of diaries in critical care � ICU stay and Pschological trauma � PTSD

Introduction to Nick � Necrotising � 16 faciitis (multiorgan failure) days in ICU � Transferred � PTSD to specialist centre for plastics – required psychological referral

Nick’s video

Our actions � Development � Diary Team � Implementation � MDT approach � Patient / relative feedback

ICRF service � Ad hoc ward visits – Inclusion criteria, ICU Steps, HADs � Telephone � Sign posting on ward � Clinic � Post contact –Visits to unit traumatic screening (PTSS 14) � Feedback loop/ change in practice to unit

Our findings……

Post-traumatic stress Mean and Median PTSS-14 scores with clinic visits 50 45 40 35 30 25 20 15 10 Median 5 0 1 2 3 Mean Median Mean

Mean and Median PTSS -14 scores with clinic visits PTSS-14 scores with visits 100 90 60 80 40 20 0 1 2 3 Median Mean 70 60 Mean Median 50 40 30 20 10 0 PTSS-14 v 2 PTSS-14 v 3

After introduction of rehabilitation pathway and patient diary Number of patients requiring follow up visits 45 40 35 30 25 20 15 10 5 0 Visit 1 Visit 2 Before pathway After pathway Visit 3

PTSS-14 before and after introduction of Rehab pathway and patient diary Anxiety levels before and after rehab pathway+patient diary 8 45 7 40 6 35 30 5 25 4 20 3 15 2 10 1 5 Before RP+Diary 0 PTSS-V 1 PTSS-V 2 After RP+Diary PTSS-V 3 After RP+Diary Before RP+Diary 0 Anx-V 1 Anx-V 2 After RP+Diary Anx-V 3 After RP+Diary Before RP+Diary

After Rehab pathway - Diary Vs No Diary 35 30 25 20 15 10 5 0 PTSS-14 After pathway- without diary Anxiety After pathyway-with diary

Patient Feedback � 98% said they benefitted from follow up clinic (score of 4 or 5 on a 5 point scale) � 97% said they would recommend the follow up clinic to their friends and family � 92% said the follow up clinic helped improve their Qo. L

“Thank-you for the personal care and attention I have received both during and after my ICU stay… not only physical care but also outstanding human and emotional care. I have made, what my family and friends say, is a remarkable recovery” “Amazing service, An amazing hospital, if only all hospitals were so good thank-you” “I cant think of any way to improve your service, everything was perfect, I would not be here today without you. A big thank-you. ” “My follow-up clinic appointments were exceptional. Let the patients talk to the ones that have experienced the follow-up or those that may have doubts about the benefits” “Excellent service I felt listened to, valued and cared for” “Visit back to unit very helpful thank-you excellent team”