Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic’s first wave

  1. Ana Cristina Castro-Avila
  2. Laura Jefferson
  3. Veronica Dale
  4. Karen Bloor

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Abstract

To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients’ future needs and care coordination.

Design

This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed.

Setting

GP surgeries and acute National Health Service Trusts in the UK.

Participants

GPs and clinicians leading care for patients discharged from ICU.

Primary and secondary outcomes

Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU.

Results

We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up.

Conclusions

The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.

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  1. Version published to 10.1136/bmjopen-2020-048392
  2. ScreenIT

    SciScore for 10.1101/2020.12.23.20248798: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: We asked for consent verbally before the start of each interview.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations of the study: To the best of our knowledge, this is the first study exploring NHS staff views on follow-up services post-ICU and plans to support patients recovering from severe COVID-19. We cannot guarantee that our sample is representative of the UK. Responses to our ICU survey were spread across the country, cover different unit sizes, increases in capacity and sizes of NHS Trusts, and are similar to those reported by Connolly, et al. 14 GP responses to the survey and interviews was low but they were spread geographically, and all agreed on the challenges of organising care for patients discharged after an ICU stay. Our GP interview findings were consistent with each other, and similar to those with larger samples conducted before the pandemic.15 Meaning of the study: possible explanations and implications for clinicians and policymakers: A number of issues raised in this study are long standing: inadequate discharge summaries, lack of clarity of responsibility for post-acute patient care, fragmented and delayed communication and limited knowledge regarding the support needs of post-ICU patients. During the pandemic, there has been RCGP training about the main post-ICU sequelae, and potential treatments.16 17 Problems in continuity of care, however, may need a joint approach to improve local organisation of care. Community rehabilitation services were described as “patchy”, with long waiting lists; an issue recognised by NHS England.18 Recent init...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.23.20248798v1 on medRxiv