Protocol for a mixed-methods exploratory investigation of care following intensive care discharge: the REFLECT study

Owen Gustafson, Lisa Hinton, Lauren Morgan, Natalie Pattison, Hilary Thomas, J Duncan Young, Peter Watkinson

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
32 Downloads (Pure)


INTRODUCTION: A substantial number of patients discharged from intensive care units (ICUs) subsequently die without leaving hospital. It is unclear how many of these deaths are preventable. Ward-based management following discharge from ICU is an area that patients and healthcare staff are concerned about. The primary aim of REFLECT (Recovery Following Intensive Care Treatment) is to develop an intervention plan to reduce in-hospital mortality rates in patients who have been discharged from ICU.

METHODS AND ANALYSIS: REFLECT is a multicentre mixed-methods exploratory study examining ward care delivery to adult patients discharged from ICU. The study will be made up of four substudies. Medical notes of patients who were discharged from ICU and subsequently died will be examined using a retrospective case records review (RCRR) technique. Patients and their relatives will be interviewed about their post-ICU care, including relatives of patients who died in hospital following ICU discharge. Staff involved in the care of patients post-ICU discharge will be interviewed about the care of this patient group. The medical records of patients who survived their post-ICU stay will also be reviewed using the RCRR technique. The analyses of the substudies will be both descriptive and use a modified grounded theory approach to identify emerging themes. The evidence generated in these four substudies will form the basis of the intervention development, which will take place through stakeholder and clinical expert meetings.

ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Wales Research and Ethics Committee 4 (17/WA/0107). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media.


Original languageEnglish
Article numbere027838
Pages (from-to)1-8
Number of pages8
JournalBMJ Open
Issue number1
Early online date25 Jan 2019
Publication statusPublished - 25 Jan 2019


  • critical care
  • mixed methods
  • outcome
  • protocol


Dive into the research topics of 'Protocol for a mixed-methods exploratory investigation of care following intensive care discharge: the REFLECT study'. Together they form a unique fingerprint.

Cite this