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S137 Failure of NICE guidance CG83 implementation: National UK survey of rehabilitation services for survivors of critical illness
  1. B Connolly1,
  2. L Denehy2,
  3. J Moxham1,
  4. N Hart3
  1. 1Department of Asthma, Allergy & Respiratory Science, Division of Asthma, Allergy and Lung Biology, King’s College London, London, UK
  2. 2Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
  3. 3Lane Fox Clinical Respiratory Physiology Research Unit, St. Thomas’ Hospital, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK

Abstract

Introduction National guidelines advocating multidisciplinary rehabilitation delivered throughout the continuum of recovery following critical illness were published in 2009 (NICE CG83). However, lack of supporting evidence for these recommendations has resulted in inconsistent implementation, particularly in the post hospital discharge phase. As expected, nursing and medical staff have been surveyed for involvement in intensive care unit (ICU) follow-up with previous surveys of physiotherapy practice focussed on within-ICU rehabilitation practice. This survey aimed to characterise post critical illness follow-up and rehabilitation following hospital discharge.

Method A predominantly closed-question, physiotherapy-specific postal survey distributed to senior critical care clinicians at UK hospitals with a listed ICU, excluding specialist-only units, and coded to facilitate respondent identification.

Abstract S137 Table 1.

Barriers to availability of post hospital discharge rehabilitation programmes for post critical illness patients.

Results Physiotherapists at 240 identified ICUs were sent surveys. 182 surveys were returned (75.8% response rate), including one blank survey. 36.5% were from university teaching hospitals, 63.5% from district general hospitals. Forty-eight centres reported follow-up services at 2–3months, the majority as clinics (39/48, 81.3%). Physiotherapists were involved in 43 follow-up services, albeit in a third of cases, on a referral-only basis. Critical care nursing staff were the main other clinician involved. Health-related quality of life (83.3%) and psychological status (81.3%) were the main items addressed, with exercise capacity reviewed in almost 60% of cases. Only 12/182 (6.6%) centres reported post hospital discharge rehabilitation programmes, all including an exercise component, but only four offering education topics. Substantial variation existed between programmes regarding eligibility, delivery format, structure, content and evaluation. Where rehabilitation programmes were not available, barriers to offering this service were detailed (Table 1). Lack of funding was the most frequently reported, and the main barrier listed. The majority of respondents (96/169; 56.8%) reported referral of post critical illness patients into alternative rehabilitation streams, predominantly accessing community and domiciliary in-patient or out-patient services.

Conclusion Data from this survey demonstrated a low level of available follow-up and rehabilitation services for post critical illness patients following hospital discharge. This reflects a lack of implementation of high-profile national guidelines, the main reason for which was reported to be lack of funding. Further investment in these services is required.

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