Rehabilitation after critical illness

1. Rehabilitation after critical illness Implementing NICE guidance 2009 NICE clinical guideline 83

2. What this presentation covers • Background • Scope • Definitions • Recommendations • Discussion • Find out more

3. 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

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

5. Definitions

6. Recommendations The recommendations cover the following areas: Information

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Information and support

14. Potential costs per 100,000 population

15. Potential benefits per 100,000 population

16. 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?

17. 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