Critical care services are atypical in the wide heterogeneity of their patients. This is in part a reflection of the way in which these services have evolved. The progress of intensive care in the UK has been described as ‘haphazard’, consisting of ‘largely unplanned and unevaluated’ developments that occurred in reaction to changes in surgical and medical practice. There has been debate about the configuration of critical care services, fuelled by a perception that there are not enough beds in some parts of the country and that existing beds are not in the right places. During the late 1990s, the NHS Executive established a National Expert Group to review adult critical care services in the UK and to produce a national Framework for future organisation and care delivery. As a result, in May 2000 a critical care modernisation plan was announced.

Over 6 million patients become critically ill each year. Of these, an increasing number will survive due to advances in critical care. However, this survival is not without cost. As the long term effects of critical illness become known, the need to design and implement effective interventions to rescue critical illness survivors from incomplete recovery has become a pressing priority for many clinicians. However, evidence based guidelines for intensive care unit (ICU) follow up and recovery remain elusive. In 2012, we started seeing patients in an outpatient team clinic designed to screen for and treat Post Intensive Care Syndrome (PICS), with the goal of promoting recovery for the sickest patients who survive the ICU. This effort was inspired by a patient in the Vanderbilt Medical ICU, and was undertaken as a pragmatic clinical intervention in an attempt to address the multifaceted yet ICU-specific problems emerging in the literature and in practice.

Our project addresses one of the pressing issues of ICU medicine—the post-ICU patient. Research has documented deficits faced by survivors of intensive care, specifically neuro-cognitive dysfunction, depression, anxiety, and post-traumatic stress. These long-lasting disabilities present an important and prevalent public health concern. Although clinicians are increasingly aware of the challenges that face ICU survivors, they do not frequently discuss this with patients or families. As a result, patients often face a bewildering number of care transitions—from hospitals to long-term care to nursing facilities—without a roadmap or community. Furthermore, there is little research that investigates which outcomes are important to ICU survivors and their families, or how to change care with these outcomes in mind.