Data collection for study: Summer/Autumn 2023 Publication date: January 2025
Aim: This study will evaluate the rehabilitation provided to critically ill adults within intensive care units, as well as throughout the recovery pathway to encompass both ward based and community care.
Objectives:
Organisational to identify:
the type of service available at hospital and arrangements for the provision of the service being investigated.
the governance arrangements, policies, and protocols on assessment of rehabilitation need and subsequent provision.
the access and availability to members of the multidisciplinary team to provide rehabilitation services to patients.
The employment of MDT members, WTEs dedicated and ring-fenced for ICU rehabilitation.
If there exists a hospital lead for ICU rehabilitation, and if so their training and experience.
the access to specialist services.
organisational structures in place to deliver the highest quality rehabilitation care and ensure seamless transition between ICU, the ward, and the community.
the access to specialist equipment eg specialist seating, mobility aids, access to gym space
is there a programme of education for step down wards on ICU recovery?
availability of rehabilitation teams in the community for primary care to refer to if long term issues are identified?
how hospitals are aligning critical care rehabilitation work programmes for service improvement.
Clinical to identify:
how physical, psychological, and cognitive rehabilitation needs are identified within the ICU..
when rehabilitation needs are identified, and what access to the multidisciplinary team is available.
whether rehabilitation was initiated at the appropriate time in ICU.
whether rehabilitation was delivered with an appropriate level of consistency.
what governance processes are in place to ensure a robust structure for rehabilitation delivery.
e.g., MDT ward round, Goal-setting meetings, individualised treatment plans
what measures of quality are used for rehabilitation delivery and patient outcomes.
e.g., which Patient Reported Outcome Measures (PROMs)?
what processes are in place for assessment of rehabilitation need at ICU discharge and how are these identified needs handed over to ward teams on step down.
whether patients’ physical, psychological, and cognitive rehabilitation needs are being met in the ward environment.
whether there is an assessment of rehabilitation needs on hospital discharge.
what follow up provision exists following hospital discharge and do patients receive ongoing rehabilitation as required, following hospital discharge.
who is responsible for coordinating rehabilitation throughout the recovery pathway.
what opportunity has the patient had to engage in discussion about their critical illness and their wishes and preferences.
to what extent are the patients views and wishes considered when developing treatment goals.
what information is provided to patients, relatives and carers within hospital and following discharge regarding critical illness, rehabilitation, and recovery and information on how to access support.
how is information regarding the patients ongoing rehabilitation needs handed over to community services (where required)?
Who is responsible for the patient’s rehabilitation needs following discharge from hospital
If the patient’s is GP provided with an appropriate summary of the patient’s hospital stay AND any ongoing rehabilitation needs.
Participating hospitals Data will be collected from hospitals in England, Wales, and Northern Ireland, in which patients can be admitted to intensive (level 3) care and hospitals where rehabilitation care is provided to inpatients as well as from primary care and community providers.
Method of data collection Patient identification
The patient identification spreadsheet will be sent out in two stages:
This will ask for a limited amount of data to identify all patients who fit the study criteria. This will include the NHS/Hospital number, DOB, sex, and ICU admission/discharge details. (Dissemination from November 2023).
This will ask for more detailed information on sixteen patients per hospital identified from spreadsheet A. This will include the details of all the community-based rehabilitation care arranged for these patients and the details of the clinical teams providing care. (Dissemination from February 2024)
In-hospital Clinician questionnaire
A questionnaire will be sent to the named consultant intensivist for each patient in the study. We will limit the number of questionnaires to 4 per consultant to minimise the burden on individual clinicians. Questionnaires can be completed by the named intensivist with input from the MDT. We will ask that the named rehabilitation lead/ coordinator at each hospital act as a ‘study contact’, to facilitate the process and to support the Local Reporter to collect the required data.
Data collected will include information on the assessment of rehabilitation needs and access to rehabilitation throughout the inpatient hospital stay and following discharge from hospital at follow-up appointment(s) for up to 1-year post-discharge.
The questionnaires will be disseminated via the NCEPOD online questionnaire system which is accessed by NCEPOD Local Reporters. The Local Reporters will then be able email the relevant clinician, granting them access to the online questionnaire. Reminder emails will be sent at six weeks and ten weeks where the data are outstanding. The Local Reporter will be asked to return copied extracts of the patient’s case notes to NCEPOD alongside the completed questionnaires.
The study will be promoted through the Intensive Care Society and the Rehabilitation CRG.
GP and community clinical questionnaire
A short questionnaire will be disseminated to the patient’s GP to identify the provision for assessment of rehabilitation needs and delivery of rehabilitation in the community, including routine follow-up appointments for up to 1 year following discharge from hospital (following the ICU stay of 4 or more consecutive days).
Hospital organisational questionnaire
An organisational questionnaire will be disseminated to all participating hospitals that will collect data on the organisational structures, policies and staffing required to deliver a high-quality rehabilitation service (as outlined in the organisational objectives)
National Data Opt-Out
From the 1st August 2022, organisations in England need to comply with the national data opt-out. If you are returning a spreadsheet to NCEPOD after this date, prior to returning the data to us, please check the listed patient NHS numbers against the National spine and remove the details of any patients who have opted out. )
PLEASE NOTE, BECAUSE OF GDPR REGULATIONS, WE ARE NO LONGER ABLE TO COLLECT CLINICIAN DETAILS WITHOUT CONSENT. WHEN ENTERING CLINICAL TEAM DETAILS PLEASE DO NOT ENTER CLINICIAN NAMES – PLEASE ONLY USE THE NAME/SPECIALTY OF THE TEAM OR A CLINICIAN CODE (THIS CAN BE A PAS CODE OR ANY OTHER THAT WOULD HELP YOU IDENTIFY THE CLINICIAN AND ALLOW US TO SELECT CASES ACROSS A RANGE OF CLINICIANS).
Local reporters!:We would be grateful if you could return the completed password protected patient identifier spreadsheet to ncepod@nhs.net by January 15th, 2024. Please then phone the office with the password to open the spreadsheet.
This page will be updated regularly so please check for further information. Any other queries relating to this study should be also addressed to icurehab@ncepod.org.uk.
This page will be updated regularly so please check for further information.
