Enhanced Recovery After Critical Care (ERACC): Developing and Testing a Care Pathway for Patients Discharged From ICU

Aim
We will design and test an electronically enabled in-hospital Enhanced Recovery After Critical Care (ERACC) pathway for patients discharged from an intensive care unit (ICU).

We aim to increase the time spent well at home after discharge from an ICU, and improve the experience of recovering from critical illness.

Background
Every year in the United Kingdom 1 in 10 (14,000) people discharged from an ICU die unexpectedly, or urgently return to an ICU before hospital discharge. Of those who leave hospital, a quarter are urgently readmitted within 3 months. This happens despite current ward support from ICUs, called “critical care follow-up". Critical care follow-up practice is not well studied and the support provided varies widely.

Standardised recovery pathways are normal in some acute conditions, but there is no established care pathway for post-ICU patients in hospital. Our prior work, with that of others, shows a new approach is required, where a pathway supports efficient proactive delivery of care to meet the unique needs of patients discharged from ICU. This pathway should be electronically supported, fitting within modern hospital systems.

Patient and public collaborators co-developed the evidence for this work, and prepared this application with us. They are an essential part of the team throughout this project.

Methods
We will divide this work into six packages. We will:

1. Work with Critical Care Follow-up teams to gain a detailed understanding of current practice. This will include similarities and differences between hospitals. Together we will use this knowledge and best practice examples to inform the content and delivery of the ERACC pathway.
2. Combine this work with literature reviews and discussions with experts (including patients and families), to identify the key patient needs the ERACC pathway can address.
3. Define how and where combinations of these key patient needs occur in the patient’s recovery pathway.
4. Work with stakeholders to develop a package of clinical interventions and an electronic support tool to meet these key patient needs within the ERACC pathway.
5. Undertake a study of the ERACC pathway in four hospitals. We will measure whether patients spend more time at home in the 3 months after discharge from an ICU when the ERACC pathway is implemented, compared to before pathway implementation. We will measure outcomes in a further four hospitals (making eight in total) without implementing the ERACC pathway. This will help us account for any changes that occur over time. We will also assess whether ERACC pathway implementation is cost effective for the NHS.
6. Ensure communication of our findings to patients, staff, hospital managers and policy makers. Approaches will include medical journals, conferences, social media and meetings with key stakeholders.