SUPPORT NEEDS AND FOLLOW-UP SERVICES FOR PATIENTS DISCHARGED FROM INTENSIVE CARE AFTER SEVERE COVID-19: QUALITATIVE INTERVIEW STUDY

A.C. Castro-Avila^1,2, L. Jefferson¹, K. Bloor¹

Background: The COVID-19 pandemic represents a challenge on several fronts, where one of them will be how the availability and form of services for Intensive Care Unit (ICU) survivors will be scaled up to cope with the increase in demand resulting from the quantity of patients and the specific features of COVID-19 and its treatment.

Purpose: To explore the views of critical care staff regarding the future needs of COVID-19 patients, and how the health service can meet those needs.

Methods: Qualitative study using semi-structured interviews. We purposely sampled 35 ICU follow up leads to have representation from the twelve regions in the UK. Recruitment continued until reaching saturation of the data. Interviews were conducted on the phone or through zoom, audio recorded, and transcribed. The interviews were analysed using thematic analysis in Nvivo to identify common themes.

Results: We conducted 17 interviews with ICU consultants (7), senior nurses (7), and rehabilitation coordinators (3) covering all UK regions.  We identified four main themes. 1. “Patients with COVID are different but are ICU survivors anyway”. The weakness, mental and cognitive issues are commonly seen among ICU survivors, but a longer-lasting deterioration of lung function, and deeper cognitive problems are expected due to the incidence of delirium. 2. “Complexity of funding streams and referrals”. Those based in England voiced that there is no direct reimbursement to hospitals for services associated with ICU follow-up clinics, so funding is constrained; consequently, services available vary greatly depending on the region. In the places with a well-established service, they had to present a business case to their hospital board to fund it. Referrals to community services were not always straightforward, requiring a referral by a General Practitioner. Waiting list for mental health and rehabilitation community services were long. 3 “The pandemic as an opportunity to change”. This was an opportunity to implement a multidisciplinary team led follow-up clinic that would not have been possible otherwise. The younger population, and the number of people affected had made visible something they had been seeing for years. 4. “Scarcity and fairness”. Follow-up for ICU survivors are a quality standard in England; however, funding was obtained by presenting a business case, leaving something else unfunded. Post-ICU rehabilitation should have a pathway as stroke and cardiac rehab have one. The extra attention to this topic is welcome, but some thought it was unfair for people who were in ICU for other reasons or before the pandemic.

Conclusion(s): The Pandemic has brought to the attention of policymakers and the public the sequela patients being discharged from ICU suffer. Complex funding streams make difficult to deliver the best care possible. Patients who had severe COVID are similar to other ICU survivors; therefore, improved follow-up should be provided to everyone through a designated funding stream.

Implications: Comprehensive rehabilitation of ICU survivors after severe COVID or other causes should be actively sought by National Health Services ensuring people can return to their previous functional level and be fully participating members of society.

Funding, acknowledgements: NIHR Policy Review Programme

Keywords: postintensive care syndrome, standard of care, Follow-up clinics

Topic: COVID-19

Did this work require ethics approval? Yes

Institution: University of York

Committee: Ethics committee of the Department of Health Sciences

Ethics number: PRP review