Novel digitally enabled care pathway to support postintensive care recovery and goal attainment following critical illness

Abstract

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Intensive care unit (ICU) survivors, particularly with a protracted length of stay such as those mechanically ventilated for COVID19 pneumonitis, experience lasting physical, cognitive and psychological challenges that impede their recovery and functional capability. Survivors also experience substantial symptom burden including breathlessness, extreme fatigue and pain. Together, the healthcare issues faced by ICU survivors are frequently referred to as postintensive care syndrome (PICS). Family members acting as informal caregivers experience substantial psychosocial burden and in some cases loss of employment and financial difficulties due to their informal caregiver commitments. Unfortunately, fragmentation in healthcare delivery following transfer from the ICU to an inpatient ward location, and following hospital discharge, is all too common. This fragmentation results in mismatches in the healthcare services needed and those received, information loss, treatment omissions, hospital readmission, and poor patient and family experience, all of which may interfere with recovery. Despite the wellestablished recovery challenges faced by ICU survivors and their family members, development of a recovery plan and provision of followup recovery services are highly variable, and in some jurisdictions extremely limited. Individualised recovery goal setting, although the standard of care across many areas of rehabilitation is not routine for ICU survivors. Virtual care and telemedicine may provide a solution to bridge the fragmentation prevalent across arbitrary healthcare system boundaries and thus enable individualised patient and familycentred recovery for ICU survivors. Although telemedicine is commonly used in the management of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD) and congestive heart failure, only a few examples exist that facilitate rehabilitation and recovery of ICU survivors such as the virtual Sepsis Transition and Recovery (STAR) programme for sepsis survivors in the USA. Therefore, as a clinical service innovation, we aimed to create a digital recovery pathway delivered via an ehealth platform (aTouchAway, Aetonix, Canada) Summary box