More must be done to help intensive care patients rehabilitate from serious conditions according to a new report, spearheaded by a Coventry University researcher.
Conducted by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and led by David McWilliams (pictured), Professor in Critical Care and Rehabilitation at Coventry University’s Centre for Care Excellence, Recovery Beyond Survival is the largest ever evaluation of rehabilitation delivery for patients with critical illness across England, Wales and Northern Ireland.
Patients who survive critical illnesses can often be left with significant physical, psychological and cognitive problems which can last months or even years after leaving intensive care units.
These can have a significant impact on their recovery with less than half of people returning to work 12 months after leaving hospital and around one in three still needing help with day-to-day activities.
The NCEPOD study, which reviewed the care provided to 1,018 patients, along with feedback from more than 200 healthcare organisations and hundreds of clinical staff, reveals a lack of co-ordination and consistency which is having a negative impact on patients’ recovery.
The report, which Professor McWilliams compiled alongside Dr Alexander Goodwin from Royal United Hospitals Bath NHS Foundation Trust, shows examples of excellent care and highlights a wide variation across England, Wales and Northern Ireland.
Professor McWilliams said: “Working with NCEPOD has enabled us to take a really deep dive into what we have long known to be a problem area, and the results of this study make for stark reading.
“Patients surviving a period of critical illness are often left with complex and multifactorial rehabilitation needs. The report has found there is often a failure to identify these needs, with a tendency to focus on medical management and physical rehabilitation without consideration of wider rehabilitation needs such as mental health or nutrition. Even where rehabilitation need was identified, access to rehabilitation was often delayed and inconsistent.
“These problems are further compounded as patients are stepping down from intensive care to the ward. Patients are moved to a variety of specialty areas related to their primary condition, meaning the availability of allied health professionals and therefore the rehabilitation provided can vary significantly. We found there is often a lack of co-ordination in this care pathway, with missing or incomplete handovers resulting in a lack of understanding of exactly what care and rehabilitation a patient needs to continue their recovery.
“A key finding of the report is an urgent need to improve the overall coordination of care for patients with critical illness. The report identifies the need for timely and comprehensive assessments of rehabilitation needs, along with better access to and more joined up working between members of the multidisciplinary team. This needs to continue as patients move through the hospital and when they are discharged home, ensuring referrals are in place and holistic rehabilitation is delivered as part of a seamless pathway.
“As NCEPOD studies provide a real world snapshot of the care patients receive, its findings and recommendations can be a very powerful tool to champion for improvement. The real challenge now is as healthcare professionals is how we meet these recommendations and optimise outcomes and recovery for our patients.”
Dr Marisa Mason, Chief Executive at NCEPOD, added: “Patients should expect the same high-quality care after a stay in an intensive care unit as they received while in the unit. It is unacceptable that patients do not receive good, planned rehabilitation; it should be a fundamental part of care with the planning starting while they are still in the unit, as delays to recovery will impact not just someone’s physical or mental health, but their return to family life, work or education.
“The findings of the NCEPOD report should be used by commissioners and healthcare providers to stimulate discussions and help improve the care they provide to current and future patients.”
To read the full study visit Recovery Beyond Survival.
