It is now well established that many patients ‏and caregivers suffer physical, psychological ‏and social problems in the years ‏and months following critical care discharge ‏(Herridge et al. 2011). Similar to many centres, ‏our intensive care unit (ICU) had no follow-up ‏service available to support patients through this ‏difficult recovery period (Griffiths et al. 2006). ‏To understand how best to create a service ‏that was safe, effective and person-centred, ‏two members of our multidisciplinary team ‏(MDT) undertook research programmes to ‏help identify the problems that patients faced ‏after ICU and to help understand the context ‏for change (Quasim et al. 2015; McPeake et ‏al. 2016).

From this work, four main challenges were ‏identified:

There is minimal evidence of how and ‏when rehabilitation services should ‏be delivered (Mehlhorn et al. 2010), ‏despite an abundance of literature ‏describing the issues for ICU survivors ‏and their families.
The hardships facing ICU patients ‏are often not apparent to hospital ‏management. Readmissions to hospital, ‏increased general practitioner (family ‏physician) visitations and the increased ‏reliance on welfare benefits are distributed ‏amongst a variety of budgets, ‏which do not necessarily appear related ‏to an ICU admission.
Finding staff with the time and ability ‏to do something new that is different ‏from their traditional ICU role can be ‏problematic.
Finding physical space with a suitable ‏area to hold a rehabilitation programme ‏can be difficult.

Critical care units’ nurses should seek to develop collaborative relationships with patients’ family members based
on their needs and help them to cope with their distress. Te objective of this study was to fnd out the perception of nurses on
needs of family members of patients admitted to critical care units.

Introduction
Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

Methods
A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated.

Results
300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).

Conclusions
Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.