The transition from being treated in the intensive care unit (ICU) to home recovery can be difficult for many patients. To help facilitate that adjustment, UCLA Health has established a Post-ICU Recovery Clinic for all patients who are discharged from the ICU after undergoing intubation for respiratory failure. Although it was conceived prior to the COVID-19 pandemic, the timing proved especially fortuitous in meeting the demand of a growing number of patients discharged from the ICU in a profoundly weakened state.
Even before the pandemic, studies found that the majority of ICU patients experience significant physical, cognitive or psychiatric symptoms during their recovery, and 20-to-30% are ultimately readmitted to the hospital in the first month after discharge. “They receive intensive care during this near-death experience, then, oftentimes, they return home to fend for themselves with new pulmonary conditions, significant weakness, cognitive dysfunction and a risk of psychiatric conditions,” says pulmonary and critical-care specialist Kristin Schwab, MD, codirector of the clinic. “We envision this clinic as a way to bridge them back to their primary care doctor and normal life.”
Pulmonary/critical-care specialist and clinic codirector Nida Qadir, MD, says it is time to provide greater post-hospitalization support for patients who have been discharged from the ICU. “As a health care team, we can’t just feel good about ourselves for saving these patients’ lives in the hospital without also considering the aftermath of what they experience after they leave,” she says. “For many, their lives have changed tremendously, and they need guidance and assistance in making that transition.”
Patients in the Post-ICU Recovery Clinic receive an in-depth evaluation by a multidisciplinary team of specialists, which includes respiratory therapists, physical therapists, occupational therapists and social workers, as well as critical care physicians to identify concerns and address all facets of their recovery. The approach has dramatically reduced the hospital readmission rate. “By intervening in this highly vulnerable time period, we’re helping both the individual patients and the hospital system,” Dr. Schwab says.
In addition, seeing patients in the recovery period produces insights that can inform ICU care. “This helps us get a better sense of our patients’ long-term outcomes, including some of the complications of what we consider to be routine care, such as how patients are positioned on the bed,” Dr. Qadir explains. “It has led to modifications in our treatment protocols. These issues may not be at the forefront of our minds when someone is close to death, but getting them to survive is not enough; we want to make sure we provide patients with the best opportunity possible at regaining as much of their former selves as they can.”
Fewer than 20 post-ICU recovery clinics existed nationally when UCLA Health launched its own. “This was identified as a need only recently, but now it is being adopted by more and more medical centers throughout the country,” Dr. Schwab says.
The holistic approach has been met with overwhelming positive feedback by patients. “They tell us they really appreciate that someone is keeping an eye on them even when they have returned home,” says Joseph Van Vleet, a respiratory therapist at the clinic. “It’s very comforting to know that there’s a team of experts that is both assisting in the clinic and watching from afar to enhance the rehabilitation process.”