Aim

We will design and test an “Enhanced Recovery After Critical Care” (ERACC) pathway to help provide every patient leaving an intensive care unit (ICU) with the best care to help them recover. We aim to help patients spend more time well and at home after leaving an ICU.

Background

In the UK 1 in 10 (14,000) people who leave an ICU die or return to ICU unexpectedly every year. Nearly a third of those who leave hospital unexpectedly return to hospital within 3 months. These poor outcomes happen despite ward-based support from ICUs, called “critical care follow-up". Critical care follow-up is not well studied, and the support provided varies widely.

Care delivery guidelines for each day of recovery – termed an “enhanced care pathway” – have improved outcomes for some patient groups. Guidelines do not exist for patients recovering from intensive care. Our previous research, with that of others, shows a post-ICU enhanced care pathway could support ward staff to proactively meet the unique care needs of patients discharged from ICU. Supporting delivery of this pathway using an electronic system will fit with the NHS aim for “digital transformation” and support efficient care provision.

Methods

We will:

1. Work with critical care follow-up staff to understand how they currently work, including similarities and differences between hospitals. This knowledge, including examples of excellent care, will help us design and deliver the ERACC pathway.

2. Combine this work with reviews of published research and work with experts (including patients and families), to identify the key patient needs the ERACC pathway must meet.

3. Define how and when specific care is needed in the patient’s recovery pathway.

4. Work with experts (including patients, family members and staff) to develop a list of care to be delivered every day (the pathway), and design how staff will use this list, to meet these key patient needs.

5. Work with sixteen NHS hospitals to test the ERACC pathway, choosing half randomly (by chance) to use the pathway. The other half of the hospitals will continue to provide their usual care. We will compare the time patients spend at home in the 3 months after discharge from an ICU, for hospitals who used the ERACC pathway and those who did not.

6. With our patient group, we will communicate our findings to patients and their families, staff, hospital managers and policy makers. We will do this through medical journals, conferences, social media and meetings with NHS decision-makers.

contact

For more information about ERACC, please contact the project team at eracc@ndcn.ox.ac.uk

Address: Kadoorie Centre, The John Radcliffe, Headley Way, Headington, Oxford, OX3 9DU