Who is responsible for follow-up after critical illness? - GP, ICU and patient perspectives

Background Critical illness is associated with a range of physical, psychological, medical and social sequalae. It is unclear from existing clinical guidance who should be responsible for follow-up of these sequalae following hospital discharge. Aim To explore the views of views of UK general practitioners (GPs), intensive care medicine (ICM) consultants, and patients on responsibility for follow-up care for critical illness survivors following hospital discharge. Methods Mixed-methods study based in the UK. Data were collected from UK ICM consultants, GPs and patients using online questionnaires, interviews, and focus groups. Analysis was informed by the Consolidated Framework for Implementation Research (CFIR). Results There was a lack of clarity within and between groups on who is responsible for follow-up. We identified various potential explanations for the lack of consensus including variable awareness of critical illness survivorship, ambiguity within clinical guidelines, lack of clarity on the boundaries of critical illness morbidity, evolving roles of healthcare providers, and significant workload and resource pressures within the UK healthcare system. Conclusion The experiences of healthcare professionals and patients indicate the current lack of clarity could negatively impacting patient care and outcomes. Consensus is required on how we should define the boundaries of critical illness sequalae, and which clinical groups are responsible for care across the various transitions of care experienced by intensive care unit (ICU) survivors.