Beyond the walls: a review of ICU clinics and their impact on patient outcomes after leaving hospital.
BACKGROUND
Patients often experience physical disability, neurocognitive and/or psychological impairment after surviving ICU. The burden arising from critical illness on patients, their families and health services may be substantial. Follow-up of these patients is important and ICU clinics have been introduced for this purpose.


OBJECTIVE
The aim of this review was to consider current research and reports from the literature about ICU follow-up clinics and their impact on patient outcomes for those who survived hospital after suffering critical illness.


METHODS
The literature review included searches of the MEDLINE, EMBASE, and CINAHL databases. Studies were included if they described the setting up and conduct of the ICU follow-up clinic that required a visit to the clinic.


RESULTS
Seven studies met the inclusion criteria, six of which were from the UK. The ICU follow-up clinics were predominantly nurse-led. There was no consensus on patient selection criteria for clinic attendance or method of follow-up. Clinic services were most often offered to patients who stayed in ICU three or more days. Attendance rates varied and were not reported for three studies. Attendance appeared to be influenced by the severity of illness. Cancellation and non-attendance rates were high for those studies reporting these data. Patients who did not live within the vicinity of the hospital were often excluded. Information about the sequelae of critical illness was provided and attendees were happy to discuss their experiences at the clinic. However, other important outcomes were not reported.


CONCLUSIONS
Appropriate follow-up for survivors of intensive care and their family is important. However, evidence is limited on the benefit of ICU clinics for patients recovering from critical illness. Further research is needed to examine models that best meet patient needs after critical care.
Williams
Teresa A
TA
Critical Care Division, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000, Australia. Teresa.williams@health.wa.gov.au <Teresa.williams@health.wa.gov.au>
Leslie
Gavin D
GD
D000359:Aftercare / Q000458:organization & administration*; D000553:Ambulatory Care / Q000458:organization & administration*; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000401:mortality / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010351:Patient Discharge; D012720:Severity of Illness Index; D017741:Survivors / Q000706:statistics & numerical data