Findings of a pilot randomised controlled trial of an early psychiatric assessment, referral, and intervention study for intensive care patients

Introduction

Intensive care unit (ICU) survivors can experience physical, cognitive, or psychological impairments that adversely affect long-term quality of life. The aim of this open-label, single-site, two-arm parallel, pilot randomised controlled trial was to assess the feasibility and acceptability of incorporating a psychiatric consultation into an existing post-ICU clinic.

Methods

Post-ICU clinic attendees were invited to participate. Consenting participants were allocated to either treatment as usual plus psychiatric review or treatment as usual using block randomisation. When attending the clinic, participants completed a standard battery of outcome measures followed by an unstructured clinical interview. The intervention arm also had a psychiatric consultation focusing on diagnostic clarification and psychoeducation within 2 weeks. All participants completed an acceptability measure after their appointment. Approximately 6 months after their appointment, participants repeated outcome measures and additional questionnaires. Data were analysed descriptively. A cost analysis assessed the time taken and cost for a psychiatrist to deliver such an intervention.

Results

Of 53 clinic attendees, 25 (47%) were invited to participate; 11 (44%) individuals consented, and 10 (91%) completed follow-up. Participants in both arms rated the interventions provided as acceptable. On a 10-point acceptability scale, the mean result for the control was 7.9 compared to 9.0 for the intervention. At 6-month follow-up, mean Hospital Anxiety and Depression Scale Anxiety subscales increased from 2.0 to 8.0 for controls but reduced from 8.8 to 4.9 for the intervention arm. Depression subscales increased from 2.7 to 6.1 for controls but reduced from 9.8 to 6.3 for the intervention arm. Mean Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual (DSM)-5 scores reduced from 54.0 to 23.3 for controls and 24.3 to 6.1 for the intervention arm. A psychiatrist providing two half-day clinics weekly could see up to 368 patients, costing AU$63,100 per year to the local service.

Conclusion

Incorporating a psychiatric assessment with standard postintensive care clinics appears both acceptable and feasible. A randomised controlled trial should further evaluate the clinical efficacy of such an intervention.