Barriers to rehabilitation after critical illness: a view from the wards
CCCF ePoster library. Rai S. Oct 3, 2017; 198218
Dr. Sumeet Rai
Dr. Sumeet Rai
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Abstract
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Barriers to rehabilitation after critical illness: a view from the wards

Rai, Sumeet; Anthony, Lakmali; Mitchell, Imogen; VanHaren, Frank



1. Intensive Care Unit, Canberra Hospital, Canberra; Australian National University Medical School, Canberra, AUSTRALIA 

2. Australian National University Medical School, Canberra, AUSTRALIA 

3. Intensive Care Unit, Canberra Hospital, Canberra; Australian National University Medical School, Canberra, AUSTRALIA 

4. Intensive Care Unit, Canberra Hospital, Canberra; Australian National University Medical School, Canberra, AUSTRALIA


Introduction: Advances in critical care medicine have improved survival of patients beyond the acute stages of critical illness. Early physical rehabilitation, minimising sedation and managing and treating delirium have all been proposed to reduce the risk of developing Post Intensive Care Syndrome (PICS) while the patients are in the intensive care unit (ICU). Continuing rehabilitation goals throughout the hospital stay is thought to add to this enhanced recovery. However, post-ICU patients may still be unwell while on the wards precluding them from active rehabilitation. It is also possible that there may be barriers which prevent timely efforts of rehabilitation. Ward staff may be in a unique position to comment on how to overcome such barriers. 
Objectives: To assess staff perceptions of PICS related issues and investigate current practices and barriers to rehabilitation for post-ICU patients on the wards.
Methods: Ethics approved single centre cross-sectional staff survey based research with a structured questionnaire consisting of open and closed questions. Online and paper-based surveys were targeted at a potential 573 multidisciplinary health professionals that cared for post-ICU patients at the Canberra Hospital. Staff were asked to reference the last post-ICU patient they cared for while responding to the survey. Main outcome measures: Ongoing patient issues post-ICU discharge; current in-patient practices and barriers to rehabilitation.
Results: Overall survey response rate was 33.7% (193/573). 190 complete survey responses were used in the final analysis. Only 44% (64/190) participants were familiar with the term “PICS”. 81% of ward staff reported that ICU-acquired new-onset weakness was a common issue in post-ICU patients and that >80% post-ICU patients required assistance with toileting and getting out of bed. The main neuropsychological problems reported by ward staff were related to sleep disturbances (63%) and agitation (41%) or delirium (41%). 52% (82/158) staff mentioned requiring to use pharmacotherapy to manage agitation/delirium in these patients. In response to the questions on the biggest concern directly expressed by patients to staff, sleep disturbance (51%) was common followed by ongoing pain issues (49%). Varied types of equipment like sling, gait harness and tilt table were used to mobilise patients on the wards. Sitting patients out into a chair was the most commonly performed mobilisation practice (66%). The major institutional barriers to mobilising patients on the wards were inadequate staffing with nursing staff shortage reported by 62% followed by lack of medical orders for mobilisation (37%) and lack of physical space near the bed (37%). The major patient barriers reported were frailty (48%), postural-hypotension/cardiovascular instability (34%), agitation (29%) and delirium (28%). Global barriers to patient rehabilitation were weakness (70%) and fatigue (63%). 61% responders wanted increase education and training about issues faced by post-ICU patients to improve patient care.
Conclusion: There are multiple modifiable barriers to the rehabilitation of post-ICU patients. Barriers to rehabilitation like lack of knowledge of PICS, absent medical orders for mobility and inadequate staff to assist mobilisation can be easily addressed. 

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