The REcovery FoLlowing Intensive CarE Treatment (REFLECT) research programme was funded by a grant awarded by the NIHR Research for Patient Benefit scheme. The first phase of this work is now complete and the results are being used to inform development of a complex intervention to improve post-ICU ward care.
A substantial number of patients discharged from Intensive Care Units (ICUs) subsequently die without leaving hospital. It is unclear how many of these deaths are preventable. Ward-based management following discharge from ICU is an area that patients and healthcare staff are concerned about. The primary aim of REFLECT (Recovery Following Intensive Care Treatment) was to develop an intervention plan to reduce in-hospital mortality rates in patients who have been discharged from ICU.
REFLECT was a multicentre mixed methods exploratory study examining ward care delivery to adult patients discharged from ICU. The study was made up of four sub-studies. Medical notes of 300 patients who were discharged from intensive care and subsequently died were examined using a Retrospective Case Records Review (RCRR) technique. Interviews were also conducted with 55 participants. Patients and their relatives were interviewed about their post-ICU care, including relatives of patients who died in hospital following ICU discharge. Staff involved in the care of patients post-ICU discharge were interviewed about the care of this patient group. The medical records of 40 patients who either survived their post-ICU stay or did not survive and had problems in their care were also reviewed using the RCRR and in-depth analysis. The evidence generated in these four sub-studies will form the basis of the intervention development, which will take place through stakeholder and clinical expert meetings.