A six year programme of research, funded by the NIHR, to design and test an enhanced care pathway for critical care survivors aiming to help patients spend more time at home after leaving ICU.
Link to NIHR plain English summary
why?
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, the REFLECT study, 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. This work will be split into six work packages.
patient and public involvement
We have included three patient and public co-applicants in the programme who will support development of a wider patient and public involvement group from the initial participating sites. Please contact us if you are interested in supporting our research or click here to leave your contact details.
Equality, diversity and inclusion
We work closely with the Oxford NIHR Biomedical Research Centre Diversity in Research Group to maximise equality, diversity and inclusion through this programme. Our work has been selected as an exemplar of inclusion in research.
research programme
qualitative study of critical care outreach support for post-icu patients
We will conduct a national survey of Critical Care Outreach Teams.
We will shadow Critical Care Outreach teams at three NHS sites to understand how they support post-ICU patients within their roles. We will also interview patients, family members and staff about their experiences of post-ICU ward care.
literature reviews
To inform intervention development, we will conduct three reviews of current literature:
A scoping review of non-pharmacological interventions delivered in hospital after ICU discharge, to improve recovery from critical illness.
An umbrella review of rehabilitation interventions delivered to frail, elderly patients in hospital
An umbrella review of nutrition interventions delivered to malnourished patients in hospital
delphi study
Informed by our previous work, the qualitative study and literature reviews, we will work with experts (including patients and families), to identify the key patient needs the ERACC pathway must meet.
cohort study
We will review the medical notes of 750 patients at three NHS sites to collect their care needs at ICU discharge and during their post-ICU hospital stay.
Intervention design and feasibility testing
We will work with patients, family members and staff at thee NHS sites to use all the information from the prior work packages to design and test the care pathway in clinical practice.
We will feasibility the finalised pathway at three further NHS sites.
cluster randomised trial
We will 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.
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
