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Abstract |
We are about to implement a nurse-based critical care follow-up service and used a follow-up study of tracheostomy to determine the feasibility of such a service. Nine to 27 months median 14 after intensive care admission we attempted to follow-up 116 of our most severely ill survivors. Twenty six could not be found, 11 declined follow-up. A questionnaire, interview and limited examination were used to determine health status. Ten patients unable to come to a clinic were seen at home. Interview time varied between patients but 79 patients took 100 nurse-hours. Ninety percent of patients co-operated with respiratory function testing. Pulse oximetry identified one with severe chronic respiratory failure. In this highly selected group of patients with on going problems (perceived poor health, dependency, disability, changes in appearance, deterioration in personal relationships, poor sleep, pain, altered diet, unaddressed chronic health problems, poor access to health services, and continuing prescription medication) were common, and addressed to some extent by appropriate referral. Approximately 20% of patients reported improvement in their health and personal relationships after critical illness and half of the smokers had given up. Factors contributing to follow-up difficulty included distance, delay in initial contact, change of address (255 of this group), disability and poverty. A nurse-run critical care follow-up clinic is feasible, time consuming but productive. A register of current addresses and phone numbers is recommended. The optimal time for follow-up will vary with patients conditions but early follow-up with protocol- based lines of referral is recommended to reduce persistent health problems |
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