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Improving Quality of Life in Patients at Risk for Post-Intensive Care Syndrome
Lisa M. Daniels, MD; Andrea B. Johnson, APRN, CNP; Patrick J. Cornelius, PT, DPT, CCS; Catherine Bowron, RN; Andrea Lehnertz, MSN, RN, CCRN; Mitch Moore, PhD, LADC; YongChun Shen, MD; Philip J. Schulte, PhD; Richard S. Pendegraft, MS; Kristin R. Hall, MS, OT, MBA; and Philippe R. Bauer, MD, PhD, FCCM, FCCP
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Critical Care Physicians, Nurses and/or Other Critical Care Medical Professionals
Objective:To improve quality of life (QOL) in patients at risk for post-intensive care syndrome (PICS).
Patients and Methods: We conducted a mixed-method, prospective, observational, pre-post interventional study in an adult medical and mixed medical/surgical/transplant intensive care unit (ICU) at a tertiary academic hospital. Pre-intervention included patients admitted from October 1 through October31, 2016, and post-intervention included patients admitted from January 15 through February 14, 2017.First, a multidisciplinary team of stakeholders identified barriers associated with decreased QOL in patients at risk for PICS. Next, interventions were designed and implemented. The effect of interventions was assessed using a mixed-method analysis. The qualitative analysis used a modified grounded theory approach. The quantitative analysis included assessment of preexisting symptoms and risk factors associated with PICS. The 36-Item Short-Form Health Status Survey (SF-36), which surveys physical and mental composite scores, was used to assess QOL.
Results:Barriers identified were lack of awareness and understanding of PICS. Interventions included educational videos, paper and online education and treatment materials, and online and in-person support groups for education and treatment. After interventions, the qualitative analysis found that patients who participated in the interventions after hospital discharge showed improved QOL, whereas education during hospitalization alone was not effective. The quantitative analysis did not find improvement in QOL,as defined by SF-36 physical or mental composite scores.
Conclusion:Interventions targeted to patients after hospitalization may offer subjective improvement in QOL for those at risk for PICS
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