The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative

Abstract

Background: Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result.

Methods: Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour.

Results: No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = -1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted.

Conclusions: The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.

Keywords: COVID-19; Rehabilitation needs; intensive care.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LTS is a full time NHS employee but, as part of her NHS activities, she directs the UK Rehabilitation Outcomes Collaborative (UKROC), She has a specific research interest in outcomes evaluation and, together with colleagues (including author RJS) she has published extensively on the development and use of standardised measures, and neither LTS or RJS has any personal financial interest in any of the material mentioned in this article. Several of the authors have clinical academic posts, and research/development publications of this kind may be used by their employing NHS or University organisation to contribute to departmental returns in evaluations such as the NHS R&D reports or the Research Excellence Framework. ZP has received honoraria for consultancy from GlaxoSmithKline, Lyric Pharmaceuticals, Faraday Pharmaceuticals and Fresenius-Kabi, and speaker fees from Orion, Baxter, Nutricia and Nestle.

© The Intensive Care Society 2021.

Figures

Figure 1.

Geographic distribution of participating centres. 1: University of Southampton NHS Trust; 2: The Princess Alexandra Hospital; 3: Queens Medical Centre, Nottingham; 4: The Hillingdon Hospital; 5: Countess of Chester Hospital; 6: Liverpool Heart and Chest Hospital; 7: Queen Elizabeth Hospital Birmingham; 8: Harefield Hospital; 9: St Marys Hospital London; 10: Norfolk & Norwich University Hospital; 11: University Hospitals Plymouth NHS Trust; 12: Royal Cornwall Hospital NHS Trust; 13: Addenbrookes Hospital Cambridge; 14: Leeds Teaching Hospitals; 15: University Hospitals Coventry & Warwick; 16: Harefield Hospital, London; 17: East Lancashire Hospitals NHS Trust; 18: Royal Liverpool University; 19: Kings College Hospital; 20: Barts Health (Newham Hospital); 21: Barts Health (Whipps Cross Hospital); 22: Barts Health (Royal London Hospital); 23: Barts Health (St Bartholomew's Hospital); 24: Wythenshawe Hospital Manchester; 25: London Northwest University Healthcare NHS Trust (Northwick Park); 26: London Northwest University Healthcare NHS Trust (RHRU).

Figure 2.

Total PICUPS scores and subscales compared between patients with (red) and without (blue) COVID-19. Data are Median (Interquartile Range). Significance was set at p 

Figure 3.

Proportion of patients requiring each discipline.

Figure 4.

Network analyses of discipline interdependencies. Panel (a) all patients, (b): with the addition of a COVID-19 infection node. Each node represents a discipline, and its size is proportional to the frequency of cases requiring that discipline. The width of edges is proportional to the correlation between nodes. A force-directed Fruchterman-Reingold algorithm determined the layout, which positions correlated nodes closer to one another.

Figure 5.

Discharge destination of patients with and without COVID-19 related admissions.

Figure 6.

Frequency of requirements for involvement of disciplines, by clinical rehabilitation plans (blue = identifed, red = delivered) and as required by the PICUPS (black).