“Doc, now I am leaving the ICU… are you going to follow me in the ward?”
“No, no, I am just the intensivist, we are the doctors who are in the ICU. In the ward you will be visited by another doctor”
This is how it works. And not only in the ward. We usually don´t know about our patients unless they re-enter the ICU or on the counted occasions when they come to visit us.
Excepting for personal interest, the really is that, in most cases, we do not follow our patients once they have left the ICU. And that follow-up is necessary.
Firstly because the patient may need it: after prolonged income in situations of high severity, no one knows better the patient than those who have attended in that circumstance and that knowledge is necessary for a favorable outcome out of the ICU. This ward follow-up is being made possible thanks to “ICU Without Walls” projects that we are carrying out in many of our centers, but it is still not the norm.
Secondly, it is also necessary because we do not know many of the sequels caused by the ICU stay in our critically ill patients. The technological and scientific knowledge revolution of recent years has allowed us to sabe extreme severity patients, but… what are the conditions? Could they reintegrate into their normal life? These sequelae do not usually have a centralized or protocolled attention.
Thirdly, it is necessary because detecting and attending these sequelae is a source of knowledge to improve our attention in the ICU to critical patients. If we know that our patients can suffer physical, cognitive or psychological sequelae, the frequency with which they occur, the intensity and the causes that can influence their appearance, we can use that knowledge to try to avoid, as far as we could, that they occur or decrease the intensity. And not only for patients, but also for their families.
Post Intensive Care Syndrome (PICS) exists and is well defined. Until now, a very few initiatives has been worked on in our country and many others. The Anglo-Saxon countries take us ahead. In Spain, the first consultation of PICS is carried by the ICU professionals of Hospital la Paz in Madrid, leaded by Dr. José Manuel Añón. They have opened the path, but this path not only need to be walked by many others: we must develop it with new ideas, adapting to our context and giving that integrating look from the humanisation point of view. The humanized ICU (HICU) doesn´t finish when the patients goes out of the ICU walls.
As a result of these pressing needs and the revolution that has meant in our environment Proyecto HU-CI, the project “INNOVA-HUCI” (preventIon, diagNosis and treatmeNt of pOst IntensiVe Care Syndrome at Hospital Universitario de FuenlabradA) has born, leaded by Dr. Mª Ángeles de la Torre. Its objective is nothing other than the one exhibited so far, integrating the health professionals (intensivists, ICU nurses, psychologist, psychiatrists, physiotherapists) with the real protagonists: patients and families. They are active part of this project that has been linked in a logical and indissoluble way the creation of a “School for families” and a “school for patients”.
There are so many things to tell about this exciting project that a single post is not enough. So we are committed to keep telling you what and how in following posts. The ICU of the present and the future need us to reinvent ourselves, to “innovate”, to cover needs that until now had been left in the dark or were not known.
Many people would think what is doing the intensivists outside the ICU following patients who are no longer in their care, that is already the task of others. It would suffice to answer with the question made by Dr. Misak: “Do you take care of the most serious patients and do not follow them after?”.
I think that’s all said. Let´s go, we’re on!