In a study conduction by the Department of Anesthesia and Intensive Care at the Haukeland University Hospital in Norway which was a follow-up of after intensive care with objectives of research of "health problems, quality of life, functional status, and memory" Kvale et al. (2003) following intensive care. Findings in brief were that further research is needed to fully understand exactly how the many psychosocial and physical possibilities of problems after a stay in the ICU are specifically related to and resulting from that stay. Kvale et al. (2003)
In the study "Leaving the Intensive Care Unit: A Phenomenological study of the Patient's Experience" conducted by the Belfast School of Nursing and Midwifery at Queen's University in the UK, McKinney et al. (2002) states that the study was focused on that which is termed "relocation stress" and is a phenomenon not examined fully or thoroughly understood in relation from the patient's transfer from ICU and stated that greater continuity of care for those recovering from critical illness. McKinney et al. (2002). Although this study focused on transfer from ICU to ward, the findings are relevant in that assuredly the discharge transfer of the patient from ICU to home is just as large an adjustment as from ICU to ward for the recovery of the critically ill patient in both psychological and physical terms.
The study entitled "Intensive Care Unit Survivors Have Fewer Hospital Readmissions Days than other Hospitalized Patients in British Columbia" conducted in 2004 and reported by Keenan et al. (2004) at St. Paul's Hospital Centre for Health Evaluation and Outcome Sciences was conducted with the objective of making a determination of the association between the number of hospital readmissions and those that were ICU readmissions as well as finds as to number of readmission days. The study was of 23, 859 patients admitted to the ICU and 40052 patients admitted to the hospital but not admitted to the ICU. No interventional methods were applied. Results show that ICU had 0.66 readmissions per year and 5.29 readmissions days within a year compared to 073 per year and 5.48 per day for the non-ICU group. Conclusions were that ICU patients surviving admission have fewer hospital readmissions than former patients that did not have a prior intensive care unit stay. Keenan et al. (2004)
In a brief review of various studies of specified medicine categories it was found through a study investigating the value of information on clinical features and intensity of treatment activity in the ICU in predicting the need for further interventional care after discharge of the patient from the ICU findings were that complications in sub-ICU patients "younger than the age of 50 are less likely" than in other patients.
Demonstrated was a linear logistic regression analysis of predictive values for sub-ICU complications and findings were that age, increased risk X 10 for patients over 50 not within the set "predetermined limits." Berardino (2000) in a separate study conducted by the Department of Intensive Care at Sir Charles Gardiner Hospital in Perth Western Australia entitled "Patient's Dreams and Unreal Experiences Following Intensive Care Unit Admission" Roberts et al. states that "Dreams and unreal experiences occur commonly in critically ill patients admitted to intensive care unit." The study is performed with 31 patients in relation to the "patient's subjective recall 12-18 months" after the ICU stay. Findings were through "semi-structured interviews that 74% of patients" who were in the ICU 3 days or longer "reported dreaming, with the majority" also reporting "frightening hallucinations" however only two of the total 31 patients were found to have sustained long-term negative psychological sequelae but short terms impacts may have not been discovered. Roberts et al. (2004)
Important and highly relevant findings are revealed in the following study as to the value of providing both oral and written instructions to ICU patients upon their being discharged from the ICU to home. In this study entitled "Written and Verbal Information vs. Verbal Information Only for Patients Discharged from Acute Hospital Settings to Home" stated is that:
Provision of verbal and written health information significantly increased knowledge and satisfaction scores." Johnson et al. (2003)
The study notes that this is particularly vital procedure in situations of educational lack or other speech or language associated complications. For example the provider of care in a large city inclusive of many spoken languages would be urged to give both oral and written instruction to the patient for aftercare upon ICU discharge.
Strahan et al. (2003) states that:
Follow-up of patients discharged from the intensive are unit is recommended as a means of service evaluation (Department of Health 2000 Comprehensive critical Care: A Review of Adult Critical Care Services) in order to monitor the quality of the services provided."
One final aspect for review in this work is that of the caregiver's responsibilities and the accompanying responsibilities of the ICU and staff in preparing the caregiver through instructional assistance at the time of the ICU patient's discharge. In a study entitled "Caregivers of ICU Patients Discharged Home: What Burden do they Face?" Chaboyer (2001) writes that:
It is therefore essential that all nurses involved in ongoing management of the ICU patients have an understanding of the caregivers role, and consider both the patient and his/her carer in the discharge planning process." Further stated is that "caregivers experience a substantial burden which is associated with the complexity of the patient's physical and psychological impairment and complex technology. To enable the impact of the caregiver further research is needed to more fully explore, examine and measure the factors involved in caring for IU patients postdischarge." Chaboyer (2001)
With all of this information in mind which has been examined as well as the studies of Daffurn (1994) or Article One of this work and that of Scraggs et al. (2001) or Article Two of this work, it is imperative that care providers in hospital ICUs or other critical care units provide the patient as well as the caregiver with ample information both verbal and written so that the proper care for the patient can be effectuated after discharge to home from the ICU. There is however, one last thing which must be considered and which both Daffurn (1994) and Scraggs et al. (2001) had not yet touched upon which is demonstrated in a study conducted by Sir Charles Gairdner Hospital Australia's Department of Intensive Care. In this study entitled "Screening for Delirium in an Adult Intensive Care Unit" it was acknowledged that there is a need for lengthy psychiatric assessment due to the fact that Nursing professionals are at the "forefront of those who are able to provide holistic care through meaningful conversation and empathetic touch." In this study all patients with ICU admission and stay of over 72 hours were screened with those admitted "following neurological insults or with pre-existing altered mental states excluded from the screening. QI results of delirium incidences were 40% of the total sampling (n=73 in a mixed medical/surgical and elective/emergency patient population."
III. Review: Comparison and Contrast of Findings:
As noted by the first two cases in this work or Articles One and Two there are differing reasons for the much needed follow-up on patients after discharge to home from ICU in order to understand the elements or factors that have the biggest impacts on the patient's well-being. As noted by Scraggs et all (2001) there were some negative discharge to home experiences among those experiencing cardiovascular disease while Chaboyer (2003) states that patients were likely to experiences resulting problems with "mobility, disability and fatigue." Further experiences of "somatic subdimensions and emotional functioning" effects were noted by Dimpoulou et al. (2004). Lastly, to reiterate the resulting information stated by Chaboyer (2003) in the importance of providing the caregiver complete information upon the patient's discharge to home from ICU for the optimization of the patient's recovery must be noted.
While the institution's care provider staff is most assuredly an element that either positively or negatively impacts the patient in terms of recovery upon discharge based on the care delivery of the provider each one of these studies demonstrates clearly that the condition or disease, illness or injury of the patient is most likely one of the two most predominant factors in the experience upon discharge home from the ICU of the recovering patient. Equally as important however, is the proper provision of both verbal and written instructions to the patient and the patient's caregiver greatly impacts the patient in terms of well-being as well as overall experience of discharge to home from ICU. Therefore recommendations from this study are the provision of verbal and written instructions to both caregiver and patient which will enable the caregiver, optimize the patient's experience and recovery and lessen the chances of future ICU admissions related to the same trauma, injury or disease.
Ball C, Kirkby M, Williams S. (2003) Effect of the critical care outreach team on…