Table 3.
Features of outpatient recovery and follow-up services
| Feature | Options | Frequency of occurrence (/130, n, %) |
|
| Eligibility criteria | Clinician referral | 60 (46.2) | |
| Self-referral | 49 (37.7) | ||
| Diagnosis | 22 (16.9) | ||
| Length of stay critical care* | 18 (13.8) | ||
| Days of mechanical ventilation† | 17 (13.1) | ||
| Therapies received | 11 (8.5) | ||
| All patients | 8 (6.2) | ||
| Other‡ | 18 (13.8) | ||
| Process for identifying eligible patients | Triage of all critical care discharges | 79 (60.8) | |
| Review of care records | 52 (40.0) | ||
| Local database | 45 (34.6) | ||
| Verbal clinician referral | 37 (28.5) | ||
| Automated IT process | 19 (14.6) | ||
| EPR request for clinic appointment | 10 (7.7) | ||
| Blanket invitation to all patients (no triage) | 9 (6.9) | ||
| Other§ | 2 (1.5) | ||
| Process of monitoring patients | Ad hoc patient list/spreadsheet | 94 (72.3) | |
| Automated process | 15 (11.5) | ||
| Electronic patient record-generated list | 13 (10.0) | ||
| Other database | 3 (2.3) | ||
| Method of patient contact regarding appointment | Postal letter | 124 (95.4) | |
| Telephone call | 88 (67.7) | ||
| Text reminder | 20 (15.4) | ||
| Other¶ | 10 (7.7) | ||
| Funding sources for outpatient services** | Funded internally from critical care funds | 65 (50.0) | |
| National health service funding | 38 (29.2) | ||
| Volunteer/goodwill only | 19 (14.6) | ||
| Other internal institutional funding | 7 (5.4) | ||
| Aspects of consultation | Review of ICU history and ICU events | 123 (94.6) | |
| Patient visit to ICU | 114 (87.7) | ||
| Assessment of sleep | 99 (76.2) | ||
| Physical function assessment | 96 (73.8) | ||
| Return/review of ICU diary | 94 (72.3) | ||
| Physiotherapy referral | 91 (70.0) | ||
| Psychological assessment | 86 (66.2) | ||
| Clinical psychology referral | 70 (53.8) | ||
| Lifestyle/risk factor review Dietitian referral |
69 (53.1) 67 (51.5) |
||
| Speech and language therapy referral | 60 (46.2) | ||
| Family/caregiver needs assessment | 54 (41.5) | ||
| Review of goals and preferences of care | 53 (40.8) | ||
| Employment/occupation review | 50 (38.5) | ||
| Assessment of sexual function | 49 (37.7) | ||
| Occupational therapy referral | 47 (36.2) | ||
| Nutritional assessment | 47 (36.2) | ||
| Pharmacy review/medicines reconciliation | 46 (35.4) | ||
| Cognitive assessment | 38 (29.2) | ||
| Vital signs/observations | 33 (25.4) | ||
| Physical examination | 33 (25.4) | ||
| Social needs assessment | 33 (25.4) | ||
| Travel assessment (eg, driving, flying) | 31 (23.8) | ||
| Assessment of financial status | 19 (14.6) | ||
| Occupational function assessment | 13 (10.0) | ||
| Speech and language assessment Psychiatric assessment |
12 (9.2) 11 (8.5) |
||
| Immunisation review | 10 (7.7) | ||
| GP referral/information | 8 (6.2) | ||
| Other†† | 7 (5.4) | ||
| Duration of appointment | New‡‡ | Follow-up§§ | |
| <30 min | 3 (2.3) | 24 (18.5) | |
| 30 min – 1 hour | 67 (51.5) | 61 (46.9) | |
| 1.0–1.5 hours | 46 (35.4) | 15 (11.5) | |
| 1.5–2 hours | 7 (5.4) | 2 (1.5) | |
| 2–2.5 hours | 2 (1.5) | 3 (2.3) | |
| 2.5–3.0 hours | 2 (1.5) | 0 | |
| >3 hours | 2 (1.5) | 0 | |
| Other | 0 | 13 (10.0) | |
| Key challenges to delivering and sustaining services | Time | 107 (82.3) | |
| Funding | 95 (73.1) | ||
| Personnel | 71 (54.6) | ||
| Space | 67 (51.5) | ||
| Perceived value or priority | 52 (40.0) | ||
| Managerial engagement | 37 (28.5) | ||
| Pressure from other services | 27 (20.8) | ||
| Staff engagement | 15 (11.5) | ||
| Other¶¶ | 10 (7.7) | ||
*≥2 days, n=6; ≥3 days, n=15; 4 days, n=6; ≥5 days, n=6; ≥7 days, n=4; >14 days, n=1.
†>24 hours, n=1; ≥2 days, n=5; ≥3 days, n=12; ≥4 days, n=6; ≥5 days, n=7.
‡Other includes the following: illness acuity, n=6; postintensive care syndrome, n=5; delirium, n=5; psychological problems, n=3; age, n=2; neurological impairment and locality, both n=1. Short length of stay (<48 hours) and/or non-ventilated patients generally not deemed eligible for follow-up.
§Other includes the following: self-referral, n=1, via support group, n=1.
¶Other includes the following: given appointment prior to hospital discharge, n=5; email, n=4; information leaflet, n=1.
**n=1 missing response. Respondents (n=7) also commented that commissioned services for some patients, for example, trauma were available; outreach services and charity support contributed some funding and some elements of some services were unfunded.
††Other includes the following: general review, n=3; signposting to local services; referral to other specialties; patient/relative feedback on service; cardiac/respiratory/exercise referral, all n=1.
‡‡n=1 missing response.
§§Other includes the following: no subsequent follow-up appointment, n=10; no consistent follow-up appointment, n=2; variable duration, n=1.
¶¶Other includes the following: None, n=2; lack of administrative support and lack of referral pathways, n=2; lack of community services, patient engagement, insufficient patient need and current pandemic, all n=1.