Post-intensive care unit clinics: models and implementation - a
systematic review
Critical Care volume 29,
Article number: 421 (2025) Published: 06 October 2025
Background
Advances in critical care have shifted the focus from
survival alone to addressing Post-Intensive Care Syndrome (PICS), which
includes persistent physical, cognitive, and psychological challenges after
discharge from the intensive care unit (ICU). While post-ICU clinics have been
established in high-income countries (HICs), their adoption in low- and
middle-income countries (LMICs) remains limited, with structured follow-up care
still under development.
Objective
To systematically review models of post-ICU clinics, examine
barriers and facilitators to their implementation, and explore their potential
applicability in LMICs.
Methods
This review was prospectively registered with PROSPERO
(CRD42024536147) and conducted according to PRISMA guidelines. A comprehensive
search of Medline, Embase, and CINAHL was completed on April 24, 2024. Studies
published after 2000 describing adult post-ICU clinic models addressing PICS
were included. Nineteen studies—comprising randomized controlled trials,
observational studies, and quasi-experimental designs—met inclusion criteria.
Risk of bias was assessed using the Joanna Briggs Institute checklists.
Thematic synthesis was guided by the Consolidated Framework for Implementation
Research (CFIR).
Results
Three primary models emerged: (1) hospital-based
physical interviews (2), hybrid models incorporating both in-person and
telehealth consultations, and (3) fully remote models using telehealth or
home visits. Telehealth/home-visit models reported the highest mean attendance
(88.7%), followed by hybrid (59%) and physical interview models (51.9%). Common
barriers included resource constraints, transportation difficulties, limited
awareness, inadequate insurance coverage, and poor interdisciplinary
coordination. Facilitators included flexible scheduling, early stakeholder
engagement, multidisciplinary team involvement, and use of telehealth
technologies. While hybrid models appeared promising for LMICs due to their
balance of accessibility and comprehensiveness, the evidence for clinical
outcome benefit remains inconclusive, and questions about cost-effectiveness
and sustainability persist.
Conclusion
Hybrid post-ICU clinic models may offer a feasible pathway
for improving follow-up care in LMICs, especially when tailored to local
constraints. However, their implementation must consider significant barriers,
particularly related to funding and infrastructure, and be guided by emerging
but still limited evidence on long-term patient outcomes. These findings aim to
inform cautious, context-specific development of post-ICU care strategies in
resource-limited settings.
