Bloom, Sarah
L.; Stollings, Joanna L.; Kirkpatrick, Olivia; Wang, Li; Byrne, Daniel W.;
Sevin, Carla M.; Semler, Matthew W.
Objectives: To examine the effect of an interdisciplinary ICU recovery program on
process measures and clinical outcomes.
Design: A prospective, single-center, randomized pilot trial.
Setting: Academic, tertiary-care medical center.
Patients: Adult patients admitted to the medical ICU for at least 48 hours with a
predicted risk of 30-day same-hospital readmission of at least 15%.
Interventions: Patients randomized to the ICU recovery
program group were offered a structured 10-intervention program, including an inpatient
visit by a nurse practitioner, an informational pamphlet, a 24 hours a day, 7
days a week phone number for the recovery team, and an outpatient ICU recovery
clinic visit with a critical care physician, nurse practitioner, pharmacist,
psychologist, and case manager. For patients randomized to the usual care
group, all aspects of care were determined by treating clinicians.
Measurements and Main Results: Among the primary analysis of enrolled
patients who survived to hospital discharge, patients randomized to the ICU
recovery program (n = 111) and usual care (n = 121) were similar at baseline.
Patients in the ICU recovery program group received a median of two
interventions compared with one intervention in the usual care group (p <
0.001). A total of 16 patients (14.4%) in the ICU recovery program group and 26
patients (21.5%) in the usual care group were readmitted to the study hospital
within 30 days of discharge (p = 0.16). For these patients, the median time to
readmission was 21.5 days (interquartile range, 11.5–26.2 d) in the ICU
recovery program group and 7 days (interquartile range, 4–21.2 d) in the usual
care group (p = 0.03). Four patients (3.6%) in the ICU recovery program and 14
patients (11.6%) in the usual care group were readmitted within 7 days of
hospital discharge (p = 0.02). The composite outcome of death or readmission
within 30 days of hospital discharge occurred in 20 patients (18%) in the ICU
recovery program group and 36 patients (29.8%) in usual care group (p = 0.04).
Conclusions: This randomized pilot trial found that a
multidisciplinary ICU recovery program could deliver more interventions for
post ICU recovery than usual care. The finding of longer time-to-readmission
with an ICU recovery program should be examined in future trials.
