Multidisciplinary ICU recovery clinic visits: A qualitative analysis of patient-provider dialogues

Chest. 2022 Oct 12:S0012-3692(22)03910-1. doi: 10.1016/j.chest.2022.10.001. Online ahead of print.

ABSTRACT

BACKGROUND: Research confirms the heterogeneous nature of patient challenges during recovery from the Intensive Care Unit (ICU) and supports the need for modifying care experiences, but there are little data guiding clinicians seeking to support patients' individual recovery trajectories.

RESEARCH QUESTION: What is the content of patient-provider dialogues in a telemedicine multidisciplinary ICU Recovery Clinic (ICU-RC)?

STUDY DESIGN AND METHODS: We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the Southeastern United States. The sample included 19 patients and 13 caregivers (>=18 years) attending a telemedicine ICU-RC visit following critical illness due to septic shock or acute respiratory distress syndrome. Patients and caregivers met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 33 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches.

RESULTS: Two themes were identified from the patient-provider dialogue: 1) problem identification and 2) problem solving strategies. We identified five subthemes that capture the types of problems identified: health status, mental health and cognition, medication management, health care access and navigation, and quality of life. Problem solving subthemes included facilitating care coordination and transitions, providing education, and giving constructive feedback and guidance.

INTERPRETATION: Patients surviving a critical illness experience a complexity of problems which may be best addressed by a multidisciplinary ICU-RC. Through analysis of our telemedicine ICU-RC dialogues we were able to identify problems and solutions to address challenges during a critical transitional phase of ICU recovery.

CLINICAL TRIAL REGISTRATION NUMBER: NCT03926533.

PMID:36243061 | DOI:10.1016/j.chest.2022.10.001