In their study, published in Australian Critical Care (24(3), 175-185, 2011) Teresa Williams and Gavin Leslie investigated the challenges, and the possible solutions, of providing long-term follow-up to patients who have survived critical illness. As part of their research, the authors undertook a literature review of 10 studies to examine the implications of those patients who were admitted to ICU and who survived critical illness, but who were not included in any study and were lost to follow-up.

 

According to the study authors, the role of the ICU is to "maximise quality of survival and function for patients who are critically ill."  Until recently, an ICU stay was considered successful if the patient survived until discharge. However, because studies have revealed that patients who return home from the ICU rarely enjoy the same functional level before being admitted, it is increasingly recognised that, post-ICU discharge, "long-term  survival, morbidity and  health-related quality  of life (HRQOL) after critical illness are as important as short-term survival."

 

Nevertheless, according to the study authors, available studies into post-ICU HRQOL mostly focus on the short-term and fail to detail the long-term effects of survival and effective follow-up services. Furthermore, it has yet to be established what post-hospital follow-up services should be available and to whom, and how to ensure that all patients receive the services and continuing support that they require.

 

According to the study, the reasons that patients admitted to general ICUs are excluded from participation or lost to follow-up include living too far from follow-up clinics, patients choosing not to participate in follow-up studies or programmes, little evidence showing that specific services optimise patient survival, and a lack of structured rehabilitation programmes for ICU survivors.

 

While it is important to establish efficient follow-up services for patients discharged from the ICU, the study authors agree that "the most appropriate method of patient follow-up and rehabilitation has yet to be established but is likely to involve an eclectic model, particularly in Australia where the population needs are diverse, culturally specific and complicated by distance and the range of health services in rural communities."

 

To do this, the authors suggest, more studies must be undertaken to identify the causes of, and thereby minimise, the loss to follow-up. Also, more needs to be done to improve understanding of patients' recovery requirements, which can then be used to inform healthcare services, and their policies and clinical practices.