Rehabilitation after critical illness
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Rehabilitation after critical illness . Implementing NICE guidance. 2009. NICE clinical guideline 83. What this presentation covers. Background Scope Definitions Recommendations Discussion Find out more . Background.

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Rehabilitation after critical illness

Implementing NICE guidance

2009

NICE clinical guideline 83


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What this presentation covers

  • Background

  • Scope

  • Definitions

  • Recommendations

  • Discussion

  • Find out more


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Background

  • Approximately 110,000 people are admitted into critical care units in England and Wales each year

  • Most patients surviving critical illness have significant physical and non-physical morbidity and undergo a lengthy convalescence

  • This morbidity is frequently unrecognised and, if identified, may not be appropriately assessed or managed


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Scope

  • The recommendations are for adults with physical and non-physical rehabilitation needs as a result of a period of critical illness



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Recommendations

The recommendations cover the following areas:

Information


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Key principle of care

Healthcare professional(s) with the appropriate competencies should coordinate the patient’s rehabilitation care pathway. As well as providing information and support, they should:

  • ensure that rehabilitation goals are regularly reviewed and updated

  • ensure delivery of structured and supported rehabilitation when applicable

  • liaise with other relevant settings 2–3 months after discharge


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During the critical care stay

  • Perform a short clinical assessment to determine the patient’s risk of developing physical and non-physical morbidity

  • Perform a comprehensive assessment to identify current rehabilitation needs and to agree short-term and medium-term rehabilitation goals for patients at risk

  • Start rehabilitation as early as clinically possible for patients at risk


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Before discharge fromcritical care

  • Perform a short clinical assessment for patients previously identified as being at low risk

  • Perform a comprehensive clinical reassessment for patients at risk to identify rehabilitation needs and to agree or review and update rehabilitation goals


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During ward-based care

  • Perform a short clinical assessment for patients previously identified as being at low risk before discharge from critical care

  • Perform a comprehensive clinical reassessment for patients at risk

  • Provide an individualised, structured rehabilitation programme for patients at risk


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Before discharge to home or community care

  • Perform a functional assessment of physical and non-physical dimensions

  • Ensure that arrangements are in place, if continuing rehabilitation needs are identified before the patient is discharged, including appropriate referrals for ongoing care


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2–3 months after discharge from critical care

  • Review the patient and perform a functional assessment of their health and social care needs

  • Refer the patient to the appropriate rehabilitation or specialist services if:

    • the patient is recovering at a slower rate than anticipated

    • the patient has developed unanticipated morbidity that was not previously identified



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Potential costs per 100,000 population


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Potential benefits per 100,000 population


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Discussion

  • At what stage do we assess rehabilitation needs?

  • How do we currently coordinate the rehabilitation of patients during and after critical illness?

  • How can we ensure adequate provision of a multidisciplinary team to deliver rehabilitation services?

  • What is the current provision of community-based rehabilitation services and do we need to improve this?


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Find out more

  • Visit www.nice.org.uk/CG83for:

    • the guideline

    • the quick reference guide

    • ‘Understanding NICE guidance’

    • costing report and template

    • audit support

    • discharge checklist

    • joint position statement