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Researchers call for plan to keep ICU patients from ending up back in hospital

British Columbia needs to act now to ensure people released from intensive care after COVID-19 treatment don’t end up back in hospital beds within months, according to a University of British Columbia researcher. Dr.
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A patient in the COVID-19 intensive care unit at St. Paul’s Hospital, April 2020. The pandemic is ‘magnifying’ a gap in post-ICU care in BC, say researchers.

British Columbia needs to act now to ensure people released from intensive care after COVID-19 treatment don’t end up back in hospital  beds within months, according to a University of British Columbia  researcher.

Dr. Fuchsia Howard, an assistant professor at the UBC School of Nursing, said the province needs to increase resources for post-intensive career recovery for all patients who experience serious illnesses.

About 80 per cent of intensive care unit patients survive. But at least half of those develop symptoms of post-intensive care syndrome regardless of their age or prior health.

The syndrome is a “constellation” of effects that can range from worsening mental health and depression to physical weakness and frailty, and can include cognitive difficulties like poorer memory, attention and mental processing speed.

And within a year, approximately half of all patients with the syndrome are re-hospitalized.

Research over the last decade has brought increased awareness of the negative health effects patients experience after leaving the ICU.

As COVID-19 hospitalizations reach record levels and keep growing in B.C., researchers are urging the province to invest in community care resources to improve patient outcomes and avoid a secondary wave of critical care readmissions.

“If we have patients who develop PICS, including COVID-19 survivors, and who aren’t getting care they need in their community, and they’re being sent back to hospital, it’s a greater burden on them and on the system,” said Howard. “We’re vulnerable to that.”

“Survival is just one indicator,” she added. “But I think we also need to think about other outcomes — having  quality of life, being able to engage in activities that bring people  meaning, going back to work, and being able to see people they love.”

In B.C., 1,151 people have been hospitalized due to COVID-19, about six per cent of the total number of cases reported up until Nov. 7. Earlier this month, the province said about 375 hospital beds remained open for COVID-19 patients.

And while 98 per cent of British Columbians infected with the virus survive, many face serious, lasting effects from the virus and their hospitalizations.

This has meant health-care workers consider ways to keep patients healthy during their care, like encouraging them to move as much as possible during their care or reducing ventilator use.

“Being sedentary is really hard on the body,” said Howard, noting that people lose two to five per cent of their muscle mass every day they spend laying down. “You can imagine that those [physical symptoms], when coupled with all they’ve gone through, makes them very vulnerable to anxiety, depression and symptoms of post-traumatic stress disorder.”

COVID-19 patients could also face stigma around having had the virus that contributes to challenges in seeking support or connection after leaving the hospital, Howard says.

Howard and Dr. Greg Haljan, a clinical associate professor in the UBC faculty of medicine, are beginning a study to determine the long-term care challenges and support needed for recovering critical illness patients in B.C.

“In part the pandemic has refocused resources towards care on survival and on acute care,” said Howard.  “Having said that, it is also magnifying this pre-existing gap for post-ICU care.”

Many patients who experience post-intensive care syndrome require follow-up physiotherapy and rehabilitation and mental health support.

But it can be burdensome to find, book and travel to appointments when someone is frail, and can increase stress and isolation for them and their family caregivers.

The uptake in virtual health appointments may be easing this, Howard said, but it has not eliminated the issue for patients.

“We know that they’re suffering in the community, that they’re lost in transition from the hospital to community care,” she said.

In an initial pre-pandemic stage of the research, funded through the Canadian Institute for Health Research, Howard said PICS patients were mostly just glad to have their challenges acknowledged.

Once the pandemic struck, researchers noticed how some early recovering COVID-19 patients found it difficult to go for a walk or spend time with family for fear of passing on the virus — even weeks or months after they were contagious.

“People were scared, and they were also feeling stigmatized,” Howard said.

Howard and Haljan are in the process of  designing a research plan to find out how and why critical care patients  with and without COVID-19 are readmitted to the hospital in order to  recommend changes the province and health authorities could make.

Howard hopes the public attention brought to recovering COVID-19 patients will lead to more robust resources for all former ICU patients, both for their own good and the sake of the health-care system.

That could include a dedicated follow-up clinic and better co-ordination between the hospital and community care after discharge.

“I would like our health-care system to shift to focus not just on survival, but really thriving and meaningful life afterwards,” said Howard.

Moira Wyton is a Local Journalism Initiative Reporter with The Tyee

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