title: After critical care: a study to explore patients' experiences of a follow-up service.
abstract: OBJECTIVE
  To establish patients' experiences after discharge from critical care and to evaluate implementation of a follow-up service.
  
  
  BACKGROUND
  Government recommendations advise critical care follow-up to prevent readmission and address problems after discharge. Admission to critical care results in significant psychological and physiological sequelae.
  
  
  METHODS
  A prospective, longitudinal and exploratory study of surgical cancer patients requiring >48 hours in critical care. Qualitative interviews were conducted and short questionnaires were used.
  
  
  METHODS
  Patient Expert Advisory Groups were invited to participate in research design. Patients were visited in the ward at days 1 and 5 after discharge, invited to nurse-led follow-up clinic and interviewed at three and six months. Short questionnaires were administered at six and 12 months.
  
  
  RESULTS
  Twenty-seven patients participated in the study. All patients experienced benefit from the service. Emergent themes included: rehabilitation from critical care: physiological issues and needs, memories: real and unreal, uncertainty and fear and empathy. A core theme of reassurance was underlying through the research. Issues while in critical care included: the need for nursing presence, nightmares, delusions, confusion, fear of ward transfer, inability to remember, disorientation and being prepared for the experience. After discharge, issues shifted to longer term needs. Psychological support, in the form of the follow-up clinic, proved useful. The ability to move on with life after discharge varied and uncertainty about the future and their cancer had an impact upon this. Recovery was made easier through the follow-up clinic. Patients required reassurances that their experiences were valid and also wanted reassurances about their cancer.
  
  
  CONCLUSIONS
  Critical care causes various difficulties for patients that may impinge on recovery. Incorporating patients into the design process helps identify needs more closely. Follow-up proved beneficial and highlighted the role nurses have in improving patient experiences after discharge from critical care. Nurses should be vigilant for both immediate and longer-term needs.
  
  
  CONCLUSIONS
  This research into nurse-led follow-up clinics after critical care highlights an important, and often neglected, part of the critical illness continuum. Attending such clinics may help reassure patients after discharge from critical care.
authors.affiliation: Critical Care Unit, The Royal Marsden NHS Foundation Trust, London, UK. natalie.pattison@rmh.nhs.uk
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Pattison
authors.forename: Shelley
authors.initials: S
authors.lastname: Dolan
authors.forename: Patricia
authors.initials: P
authors.lastname: Townsend
authors.forename: Rachel
authors.initials: R
authors.lastname: Townsend
mesh_terms: D003422:Critical Care; D003625:Data Collection; D005500:Follow-Up Studies; D006801:Humans; D010361:Patients / Q000523:psychology*