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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 19-23

Postintensive care unit follow-up general health survey: A cross-sectional study in a tertiary academic hospital


Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Submission21-Mar-2021
Date of Acceptance12-Apr-2021
Date of Web Publication24-Jun-2021

Correspondence Address:
Ohoud Aljuhan
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P. O. Box 80260, Jeddah 21589
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sccj.sccj_10_21

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  Abstract 


Background: Despite the tremendous efforts regarding post hospital discharge services, the literature regarding health status, social and medical support of ICU survivors in Saudi Arabia is very limited. The main aim of our study is to conduct a general survey to describe health, medical and social status of ICU survivors. Methods: This was a cross- sectional study conducted at a tertiary academic center in Saudi Arabia. The phone survey has been conducted by the study investigators after getting a verbal consent for participation. A list of patients who were discharged from the hospital after an intensive care unit's admission from January 2018 to December 2018 was obtained. Results: Majority of our participants have no issues in concentration and only small percentage reported that they experience one or more of anxiety, depression, despair, and blue mood. A larger percentage of our subjects were satisfied by the support they received from their relatives, social support, and access to medical services. Conclusion: ICU survivors discharged from one center in Saudi Arabia reported great general health and satisfied by social and medical support but functional and mental status and multidisciplinary team approach worth further investigations.

Keywords: General health, intensive care unit survivors, medical services, post- intensive care unit, quality of life, Saudi Arabia, social status


How to cite this article:
Aljuhan O, Tirkistani A, Albeeshy M, Alnahdi A. Postintensive care unit follow-up general health survey: A cross-sectional study in a tertiary academic hospital. Saudi Crit Care J 2021;5:19-23

How to cite this URL:
Aljuhan O, Tirkistani A, Albeeshy M, Alnahdi A. Postintensive care unit follow-up general health survey: A cross-sectional study in a tertiary academic hospital. Saudi Crit Care J [serial online] 2021 [cited 2021 Oct 27];5:19-23. Available from: https://www.sccj-sa.org/text.asp?2021/5/2/19/319309




  Background Top


The main goal of providing critical care services to intensive care unit (ICU) patients is to save their lives and to ensure better health-related outcomes. This includes patients return to the preadmission level of function and normal health status.[1] During ICU stay, critically ill patients are at high risk of deterioration of their physical condition because of the high level of stress, urgent treatments, and disability to communicate. In addition, ICU survivors are suffering from medical, physical, and social limitations.[2] The majority of ICU survivors develop anxiety, depression, and posttraumatic stress syndrome, which affect their quality of life significantly after hospital discharge.[3] In comparison with normal individuals, these patients often develop physical, functional, and psychological deterioration, affecting their health-related quality of life (HRQoL).[4]

Prior studies have concluded that the ICU length of stay (LoS), age, and severity of illness before ICU admission were the most important factors in HRQoL deterioration after ICU discharge. These studies state that the recovery is incomplete for physical function, general health, and social function compared to the normal people after ICU discharge. A systematic review concluded that improvements in quality of life occurred in the 1st year after discharge in four domains: physical function; physical role; vitality; and social function.[5] Additional study has concluded that patients at 18 months after discharge have worse status than admission level. This study has determined that age, ICU LoS, and male sex were the strongest factors that impacting the quality of life (QoL) on admission and 18 months after ICU period.[6] Another trial suggested that patients regain their age-specific HRQoL 5 years after their ICU discharge.[7] Few other studies investigate the influence of family and social support on HRQoL. One study recommended that institutions should implement a post-ICU support programs targeting both patients and relatives to help in the need for social support and to improve the patient status.[8]

Conventionally, the main outcome for successful critical care has mainly focused on mortality and assessment of the health of survivors in terms of physiological, radiological, and biochemical measurements. Recently, there has been a global move toward outcomes that take into consideration patient's QoL. In Saudi Arabia, the Ministry of Health (MOH) has placed particular emphasis on expanding the critical care services and promoted services accessibility and feasibility. According to Al-Omari et al., MOH has embraced several projects and redirected the necessary funds for these programs, such as establishing and developing new general hospitals, medical cities, and specialist hospitals.[9] Recently, MOH in Saudi Arabia has initiated a home visit program for people who need long-term care after hospital discharge aiming to improve health-related outcomes.

There is very limited research regarding the assessment of post-ICU survivor's health status. One study aimed to determine the functional status among survivors of severe sepsis and septic shock a year after hospital discharge from a tertiary hospital in Saudi Arabia.[10] The study found that only one-third of the survivors of severe sepsis and septic shock had good functional status 1-year post discharge.[10] Another study concluded that Middle East respiratory syndrome (MERS) survivors of critical illness reported lower quality of life than survivors of less severe illness.[11] However, when it comes to studies that measured the effect of different types of support for patients after ICU discharge, most of them have been done outside Saudi Arabia, showing a significant gap in literatures on ICU survivors in Saudi Arabia.

Study aims

The main aim of our study is to conduct a general survey to describe the health status, medical support, and social status of ICU survivors, in addition to assess the effect of ICU LoS on the general well-being of ICU survivors post discharge.


  Methods Top


Study design and setting

This was a cross-sectional study conducted at a tertiary academic center in Saudi Arabia. The hospital has a bed capacity of 1067 beds, and ICUs admit medical, surgical, and cardiac patients and operate as a closed unit with 24/7 onsite coverage by critical care intensivists. After 24 h of ICU transfer, an intensivist can follow up the patient care while admitted in the hospital. However, there is no specific process for following ICU survivors beyond hospital discharge. The University's Institutional Review Board (Ethics Committee, approval number: 422-18) approved the study, and verbal consent was obtained from all patients in the study before survey participation.

Patient selection and study procedure

Adult patients 18 years or older who were discharged from the hospital following an ICU admission were included. We selected patients who were discharged from the hospital within 1 year after their ICU admission by retrieving their information from the electronic medical records. Patients who have language barriers or those who changed their contact information were excluded. A list of patients discharged from the hospital after an ICU admission from January 2018 to December 2018 was obtained. Two investigators reviewed the list and contacted the patients for possible survey participation. Enrollment was based on the patient's willingness to participate and the availability of accurate contact information. There were approximately 361 potential patients eligible for participation. Of these patients, 124 met the inclusion criteria, and 50 of them completed the survey.

The investigators of this study contacted the eligible patients to perform the follow-up phone survey. Verbal consent and agreement to participate in the phone survey were obtained from the participants before conducting the survey. The survey was extracted from a validated survey WHO-BREF for HRQoL.[12] The abbreviated survey has been tested and validated on a small subset of participants before utilizing it to the whole group. The investigator read each question to the patient directly from the survey using the same script. The following data were collected from the electronic health records for all patients including age, gender, reasons of ICU admission, type of ICU services, and length of ICU stay.

Outcome measures and data analysis

In our study, the survey was used to assess the general health status of ICU patients following hospital discharge. Since WHO-BREF measures HRQoL, it was well-suited to describe the general health status of our participants based on utilizing an abbreviated form of the validated Arabic version of it. The final abbreviated survey contains ten questions related to the general quality-of-life domains, including questions about physical health, medical services, mental/psychological status, and social and family support. Each question is rated based on a-5 point scale, for example, 1 = not much, 2 = not at all, 3 = moderately, 4 = completely, and 5 = great deal. Each response was analyzed using descriptive statistical analysis with numbers and percentages by utilizing IBM SPSS Statistics for Macintosh, Version 25.0 (IBM Corp., Armonk, NY). All data were analyzed using descriptive analysis tools and presented as a percentage. A linear regression test was used to identify the relationship between ICU LoS and level of quality of life.


  Results Top


Participants baseline characteristics

A total of 50 patients consented to participate in the study. The mean age of the survivors was 54.5 years (standard deviation [SD] 17.18) and 58% (29) were female. Most patients were admitted to surgical ICU (54%, 27), 22% (11) were admitted because of cardiovascular reasons, and the remaining were admitted due to oncology (19%, 9) and pulmonary and infectious disease 14% (7) of each. The mean length of the participant stay in the ICU was 8.1 days (SD 7.51) [Table 1].
Table 1: Baseline characteristics

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Main Results

Postintencive care unit general health status

At the time of the survey, 76% of the ICU survivors reported a great quality of life after hospital discharge. More than half of the participants were satisfied with their health status, and they reported that they were enjoying their life. Twenty-two of the subjects agreed that physical pain is limiting their daily activities, a similar number reported that they need medical treatment to help them functioning. Most of our participants admitted had no concentration issues, and only 12 (24%) agreed that they experience one or more of anxiety, depression, despair, and blue mood. A larger percentage of our subjects more than 60% were satisfied by the support they received from relatives (82%), access to medical services (66%), and their environment (66%) [Table 2].
Table 2: Survey results for general health status

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Correlation between LOS intensive care unit and overall health status postintensive care unit

We were interested in assessing the effect of ICU LoS on ICU survivor's general health. A simple linear regression was conducted to predict the association between ICU LoS and the general health status, P = 0.22 suggests that the ICU LoS is not a predictable for changing in health status post-ICU discharge.


  Discussion Top


This cross-sectional study focused on conducting a post-ICU discharge general health survey. Our study illustrates that ICU survivors within 1 year following ICU discharge have reported good well-being, and they are satisfied with the level of their quality of life. Our study findings are different than the findings of one study that reported lower quality of life of MERS survivors following critical illness in Saudi Arabia.[11] QoL understanding and acceptance of general health measures in our population is different compared to published studies worldwide.[2],[3] A justification for this might be the cultural and religious beliefs of our participants, especially being thankful to survive the critical illness. Furthermore, we conducted the survey on a mixed ICU population, surgical ICU survivors who admitted for close observation after operation might have better general health and quality of life due to better baseline conditions and fewer comorbidities.

Nonetheless, conducting an early posthospital discharge to assess overall health survey is essential to be undertaken by multidisciplinary team of health-care providers to identify early health-related issues. Nurses, physicians, and pharmacists can work together to assure the well-being of ICU survivors and to optimize their QoL and drug-related problems. There are several services that can be provided to ICU survivors, included but not limited to conduct phone surveys following ICU discharge to early identify health issues, perform comprehensive medication management services, counsel ICU survivors and their relatives, and address health preventive measures. A recent opinion paper identified and described services for managing ICU survivors and supporting their caregivers in ICU recovery clinics (ICU-RCs). The paper concluded that an interprofessional team in ICU-RCs could play a vital role to promote education on postintensive care syndrome (PICS), improve medication adherence, ensure comprehensive medication management and medication reconciliation, provide an assessment of inappropriate and appropriate medications after hospitalization, and address adverse drug events.[13]

Our findings related to ICU survivors' pain and requirement of medical treatment to perform daily functional activities is similar to those reported in ICU follow-up studies. A prospective study conducted to assess the functional status of ICU survivors 3 months after discharge has concluded a fall in the physical activities following ICU discharge.[14] An important aspect that needs to be addressed for ICU survivors in Saudi Arabia is which patients are at higher risk of functional status decline following ICU discharge. A prospective multicenter trial conducted in Canada reported that the level of the frailty of ICU survivors was linked with greater impairment in HRQoL, functional dependence, and disability compared with those not frail.[15]

Within 1-year post-ICU discharge, most of the participants in our study have reported mental health-related issues such as depression, anxiety, and/or blue mood, these findings are in agreement with one of the well-known major health-related problems post-ICU discharge. Most patients who survive an ICU admission develop health-related issues which are defined as PICS that start in the ICU and persist after discharge. This syndrome can affect the patient's physical, mental, and emotional well-being. PICS is considered one of the challenges for ICU survivors and their families because half of the patients never return to their baseline status.[2],[3],[16],[17] One meta-analysis was conducted to evaluate anxiety symptoms 1 year following ICU discharge and found that one-third of ICU survivors experience anxiety symptoms that are persistent during their 1st year of recovery.[18] Post-ICU anxiety and other psychiatric-related issues for ICU survivors deserve national efforts into standardize their management and follow-up.

ICU survivors in our study reported satisfaction with family, social, and medical support within 1 year following discharge. Family support has been reported in several studies as a key factor in improving ICU survivorship. According to one study, social support has a direct proportion with QoL improvement, showing that subjects who have good support have a better HRQoL.[8] Identifying patients' support needs following critical illness is another aspect worth further investigation to help organizations and decision-makers to understand the needs at different transition periods.

ICU LoS was not correlated with the general health status following ICU discharge within 1 year. Our study is not intended to assess the determinants of QoL, but it helps to bring attention to this aspect in ICU survivors for more investigation on determinants of HRQoL after ICU.

Our study is subject to several limitations. First, selection bias may be present, this small study sample in one center may not represent all ICU survivor health status in Saudi Arabia. Second, due to limited medical documentation, specifically information related to the severity of illness, dependence on the ventilator, and exposure to sedatives or neuromuscular blocking agents, which might be an important factor in HRQoL outcomes assessment. Third, we conducted the abbreviated survey through phone and not in person, so the validation of phone versus self-administered survey and accuracy of participant understanding is questionable since a long time has passed after their ICU admission. Finally, our findings are limited to be generalized to all ICUs survivors, since we included only adult mixed surgical and medical ICUs patients. Future studies that take in consideration pediatrics, neuro, and cardiac ICUs survivors are needed.

This cross-sectional study has provided some preliminary information regarding the general health status and support for ICU survivors in Saudi Arabia. Prospective longitudinal multicenter studies to assess the correlation between ICU admission and post-ICU health-related outcomes are highly needed. Information from these studies will help in service provision and stimulate different initiatives related to improving ICU survivors' quality of life.


  Conclusions Top


Within 1-year, ICU survivors discharged from one academic tertiary care center reported great general health and satisfied by social and medical support. Further attention is needed to assess determinants of functional and psychological well-being of ICU survivors. Future efforts should be directed to long-term outcomes and initiatives to support this population in a multidisciplinary approach.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Tabah A, Philippart F, Timsit JF, Willems V, Français A, Leplège A, et al. Quality of life in patients aged 80 or over after ICU discharge. Crit Care 2010;14:R2.  Back to cited text no. 1
    
2.
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Myhren H, Ekeberg O, Tøien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care 2010;14:R14.  Back to cited text no. 3
    
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Hill AD, Fowler RA, Pinto R, Herridge MS, Cuthbertson BH, Scales DC. Long-term outcomes and healthcare utilization following critical illness – A population-based study. Crit Care 2016;20:76.  Back to cited text no. 4
    
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Gerth AM, Hatch RA, Young JD, Watkinson PJ. Changes in health-related quality of life after discharge from an intensive care unit: A systematic review. Anaesthesia 2019;74:100-8.  Back to cited text no. 5
    
6.
Fildissis G, Zidianakis V, Tsigou E, Koulenti D, Katostaras T, Economou A, et al. Quality of life outcome of critical care survivors eighteen months after discharge from intensive care. Croat Med J 2007;48:814-21.  Back to cited text no. 6
    
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Hofhuis JG, van Stel HF, Schrijvers AJ, Rommes JH, Spronk PE. ICU survivors show no decline in health-related quality of life after 5 years. Intensive Care Med 2015;41:495-504.  Back to cited text no. 7
    
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Tilburgs B, Nijkamp MD, Bakker EC, van der Hoeven H. The influence of social support on patients' quality of life after an intensive care unit discharge: A cross-sectional survey. Intensive Crit Care Nurs 2015;31:336-42.  Back to cited text no. 8
    
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Al-Omari A, Abdelwahed HS, Alansari MA. Critical care service in Saudi Arabia. Saudi Med J 2015;36:759-61.  Back to cited text no. 9
    
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Al Khalaf MS, Al Ehnidi FH, Al-Dorzi HM, Tamim HM, Abd-Aziz N, Tangiisuran B, et al. Determinants of functional status among survivors of severe sepsis and septic shock: One-year follow-up. Ann Thorac Med 2015;10:132-6.  Back to cited text no. 10
    
11.
Batawi S, Tarazan N, Al-Raddadi R, Al Qasim E, Sindi A, Al Johni S, et al. Quality of life reported by survivors after hospitalization for Middle East respiratory syndrome (MERS). Health Qual Life Outcomes 2019;17:101.  Back to cited text no. 11
    
12.
WHOQOL Group (1996, December). WHOQOL-BREF Introduction, Administration, Scoring and Generic Version of the Assessment. Available from: http://www.who.int/mental_health/media/en/76.pdf. [Last accessed on 2018 Feb 26].  Back to cited text no. 12
    
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Mohammad RA, Betthauser KD, Korona RB, Coe AB, Kolpek JH, Fritschle AC, et al. Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy. J Am Coll Clin Pharm. 2020; 3:1369-79.  Back to cited text no. 13
    
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Zeggwagh Z, Abidi K, Kettani MN, Iraqi A, Dendane T, Zeggwagh AA. Health-related quality of life evaluated by MOS SF-36 in the elderly patients 1 month before ICU admission and 3 months after ICU discharge. Indian J Crit Care Med 2020;24:531-8.  Back to cited text no. 14
    
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Bagshaw SM, Stelfox HT, Johnson JA, McDermid RC, Rolfson DB, Tsuyuki RT, et al. Long-term association between frailty and health-related quality of life among survivors of critical illness: A prospective multicenter cohort study. Crit Care Med 2015;43:973-82.  Back to cited text no. 15
    
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Eddleston JM, White P, Guthrie E. Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 2000;28:2293-9.  Back to cited text no. 17
    
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Nikayin S, Rabiee A, Hashem MD, Huang M, Bienvenu OJ, Turnbull AE, et al. Anxiety symptoms in survivors of critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2016;43:23-9.  Back to cited text no. 18
    



 
 
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