Give critically ill patients rehab goals within four days, says NICE

Patients in critical care, who are at risk of morbidity, should have their rehabilitation goals agreed within four days of admission.


The standard aims to improve the care of adults in critical care

This is according to a new quality standard published on 7 September by the National Institute for Health and Care Excellence (NICE).

It outlines ways of improving the care of adults who are in critical care for more than four days, and are at risk of a physical morbidity, such as muscle loss, or a non-physical morbidity such as cognitive dysfunction.

The standard advises that physiotherapists, and other healthcare professionals, should provide these patients with

  • an individualised, structured rehab programme when they transfer from critical care to a general ward
  • information about what to expect after discharge, based on rehab goals agreed during their hospital stay
  • a review, two to three months after discharge, which includes a functional reassessment of their health and social care needs

David McWilliams, a consultant physiotherapist who works in critical care for University Hospitals Birmingham NHS Trust, was a member of the quality standard’s development group.

He told Frontline it builds on recommendations set out in the 2009 NICE clinical guideline on rehabilitation after critical illness in adults, and addresses areas that still require improvement.

‘What we are learning now is the importance of a robust structure of delivery for rehab within critical care, underpinned by a positive culture of team working and communication,’ he said.

‘This quality standard offers measurable standards to support this structure and will be of great benefit to both physiotherapists and patients.

‘It underlines the key role physiotherapists have in the planning and coordination of rehabilitation, both within critical care – delivering early rehab – and in the weeks and months following discharge.’

Potential tool to help commission services

Rachael Moses, a physio consultant at Lancashire Teaching Hospitals NHS Trust, welcomed the quality standard’s focus on continuing to support people after critical illness.

‘The original clinical guideline focussed mainly on rehab while the patient was still in critical care and immediately post ICU discharge,’ she told Frontline.

‘But there is growing evidence supporting ICU follow-up clinics and rehabilitation in the community setting.’

She added that commissioning such services often proved difficult at a local level, but health professionals could use NICE quality standards to help benchmark their services, risk assess, identify a need and demonstrate the necessity for a relevant service.

‘The wider socio-economic impact of patients getting back to work and education quicker, if they have access to high quality rehabilitation across the whole pathway, should be the next focus as research moves forward,’ she said.

Author: Robert Millett

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