Improving information-giving to critical care patients to guide post discharge rehabilitation: a quality improvement project

Purpose

ICU survivors have a 1-year mortality rate of 30%, and a reduced quality of life associated with post-ICU syndrome; a triad of cognitive decline, physical weakness and psychiatric disorders. Early rehabilitation improves outcomes, leading to greater independence. The NICE CG83 guidelines instruct the provision of rehabilitation information to critical care patients on discharge. Currently, only a third of UK trusts meet these guidelines.

Within 20 weeks, we aimed to achieve 100% patient and therapist satisfaction with the rehabilitation information given to patients at risk of physical morbidity on discharge from critical care at Medway Maritime hospital.

A shift was observed in critical care patient satisfaction scores,
indicating a significant change in the median from 20% at baseline to 70% after PDSA2.
This was also reflected in the therapist satisfaction scores
which increased significantly from 60% at baseline to 80% after PDSA2.

Approach

Critical care patient and therapist (phsyiotherapists, occupational therapists and dietitians) satisfaction was assessed using questionnaires at baseline and after each Plan-Do-Study-Act (PDSA) cycle. In PDSA1, a generalised rehabilitation information booklet was introduced. In PDSA2, a personalised rehabilitation plan for pre-discharge completion by the therapists was added.

Outcomes

A shift was observed in critical care patient satisfaction scores, indicating a significant change in the median from 20% at baseline to 70% after PDSA2. This was also reflected in the therapist satisfaction scores which increased significantly from 60% at baseline to 80% after PDSA2.

The introduction of a generalised information booklet, supplemented with a personalised recovery plan, is an effective way of increasing critical care patient and therapist satisfaction with post-discharge rehabilitation information provision. This should translate to greater critical care patient engagement with rehabilitation and improved long-term outcomes. To further increase satisfaction, the addition of psychiatric input to the booklet is currently underway.

Implications

Providing critical care patients with an information booklet, which is supplemented with personalised rehabilitation information is an effective way of meeting NICE CG83 guidelines and improving patient satisfaction. Supplementing out-of-hospital rehabilitation with information should further improve engagement and lead to improved patient outcomes.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2019