Chapters Transcript Post-Intensive Care Syndrome So I'm Jan Clues, and you've been introduced with Mike Siegel. And today we're gonna talk about Post I see you post intensive care syndrome. And also we're going to talk about an ICU Survivor support group that we have that actually includes our post covid patients. We both have no disclosures. Yeah. Um, at the end of our session, we're hoping that you'll be able to describe post intensive care syndrome, that you'll be able to know what some of the risk factors are, What some interventions are that you can do while the patients in the ICU or recovering on your floor to help them recover and reduce the length of time they might have this post ICU syndrome. Um, and we want you to develop an I will statement, and we want you to develop an I will statement in regards to mobilization because and Mike will tell you some more about that. But it's extremely powerful in in as an intervention to help our patients. So post intensive care syndrome is actually a constellation of health problems that occur sometimes beginning when the patients in the ICU. But we see it more frequently after they've been discharged, and I just want to take a quick poll. How many? How many of you Who, When you transferred your patient to the floor or those of you who have gotten a patient on one of the floors. I thought that when your patient was discharged, they're just gonna be a okay, continue with their recovery, go back to the life they had and just pick up where they left off. Just show of hands. Okay, So a few of you, and actually in the nursing and medical community, we did think that for many years we just felt like they're going home. Everything will be fine. What follow up will be needed. Could be conducted by the primary care physician. So some of these symptoms that we're talking about our physical, mental, emotional, cognitive. There's a variation and severity. Some patients have little amounts of these problems. Some people have more severe amounts of the problems. And then we have patients who maybe have one or two or many of the, um, symptoms. So can anyone hear me? Okay. Yes. Yeah. So I like this slide a lot. This is kind of demographic. Jan kind of just touched on, Um, it's really kind of speaks to all the different things that people with post intensive care syndrome have. It could be described along the lines of PTSD again. Just kind of just go through some of the pics, what that actually stands for depression, weakness, some kind of being misunderstood and not knowing where to go after the ICU. And that's kind of how we came up with this whole mantra we speak to is called Beginning with the End in Mind. So we begin care of the patient in the ICU. Everyone knows we're kind of going through life saving measures and what's next? So we're beginning rehab with the end of mind. You know, we know patients can end up with all these symptoms. That's why we try to intervene early. And I'll touch on that as we go forward, both as nurses, rehab specialist physicians, restaurant therapy, Kind of going to the whole eight run bundle. So that's kind of what this, you know, represents okay. So, specifically, some of the impairments that we see with patients with post ICU syndrome the physical ones are, um, dysfunction with pulmonary status. Um, patients have weakness or less loss of balance. Patients have problems with walking for mental health. Many patients develop anxiety, and you probably see that while they're in the in the I c. U, and or after they've been transferred to the floor, patients can develop depression or PTSD as a result of some of those things. They have impaired sleep, which kind of only fuels some of the emotional distress that they develop. And generally, we do see that patients who have had critical illness of one sort or another have a problem with malnutrition. Again, that feeds into the constellation of other impairments. Some of the cognitive features that we see with our patients as they have poor thinking ability as far as executive. So, um so patients can say they aren't able to organize their pills, or they can't remember how often they should be taking their medications or they can't pay bills. Just that kind of executive function is not something that is as clear as it had been before for them previously, other patients have problems with memory forgetfulness. Um, some patients will call there. Their brain function is foggy, foggy thinking. So now we're going to kind of break down some of these impairments to go through a little bit more specifically, starting with physical impairments. So I think people, you know, it's kind of come out and literature a lot lately. How much how weak patients can get in the ICU. But it's kind of a little more real and more staggering when you see the post ICU clinic when people are you know, more than six months out of ICU stay and they're still having trouble walking. I can't return to work. But up to 80% of patients in the developed some sort of neuro muscular dysfunction. This can be described as icy acquired weakness, something that the thought of a therapist in the ICU working with the patients kind of screen for this may include. You know, Polly in Rapa these described as critical as pollen apathy or critical illness myopathy. Uh, so again, I think everyone thinks about arms and legs, but it's also really affects the pulmonary muscles. Cardiopulmonary function, your diaphragm, you know, super effective. So I when you get people off the ventilator, which causes another myriad of problems so people can get muscle atrophy, so we kind of go through its medical research council grading scale. To grade this again, we do our main muscle testing of you Do your shoulders so your shoulder deltoids your elbow flexion elbow extension so those scores are out of five. So add this up and then you do hip flexion. Knee extension endorsed reflection, so total score is 60. If you score less than 48, then you're positive for ice. Required weakness. Um, so kind of give you some more background on that. I see a query. We just contribute to again prolonged mechanical ventilation again because of that diagram. Weakness. Um, increase. I like to stay. Increase half the length of stay and, of course, great impairments upon discharge from the hospital. Greater mortality. So who's at a bigger risk for icy, acquired weakness? Females? People who are septic people have more than one organ involved people who have served a systemic inflammatory response. The longer run, the ventilator, the week your diaphragm gets and, of course, being immobile. So we try to combat this all with doing you know, I see rehab talk about in a minute. This side kind of just breaks it downward from what they call an I C F model. So international classification to function. This really is like if you want to nerd out on P. T. This is what you kind of go through. It kind of breaks it down into body structure and function. So it just kind of give you some background on what? As a therapist we're looking at when you see patients in the ICU and we're looking at body structure and function, we're looking at range of motion testing, muscle strength. Um, and then we want to accept limitations so this patient can't walk very far. So we do a six minute walk, test this, you know, and there's a myriad of other tests. Balance test. So this is the things we screened for in the PICS clinic. We kind of run through all these tests with our patients. Participation restrictions is more like returning to work, returning to driving, getting more of those high level functions. Um, more about the i c f model. So this kind of really puts this was a systematic review that we looked at just kind of see how impaired our patients are and what time frames. So we read a bunch of articles and looked at pulmonary function. So I think we think about muscle strength and we forget about pulmonary function and how important it is. So still, at six months, post ICU say, 65 to 88% of patients still had decreased pulmonary function. Um, inventory muscle strength was reduced 3-6 and 12 months. This is kind of why we picked these timeframes to follow up with patients. Overall, decreased muscle strength and this was specifically hand strength Was still decreased at 3, 6 and 12 months compared to baseline. And so is the extension and elbow flexion extension. So patients overall still had decreased six minute walk test and decreased exercise capacity at three month follow and 55-80% of patients 35% of patients in this systematic review had partial dependence of at least one a D. L three months post ICU stay. only 61% return to driving, and then even lower numbers return to work. So just think about that impact on the economy, the impact on personal life, the impact on the caregiver of the family, um, again, massive impacts. So what do we try to do with this? We try to begin with the end in mind, so we want to intervene early. Um, so that's the whole reason that we think that many of you know at CMC we start our I C rehab back in 2015. We wanted to intervene early, identify patients appropriate for rehab in the ICU and identify patients who had potential with fixed impairments. Again, really focus on those patients and workers Inter disciplinary team to provide the best care we could for those patients next time. We really did was, you know, work on providing education to support families, support patients, teaching patients and families range of motion. We'll talk a little about how we worked on an icy diary program the occupational therapist really focused on. They're actually gonna do a new pilot starting next year with, um Then we wanted to engage our families in the rehab process, right? Getting people from moving his access to P t. Things. That s O. T thing. You know, nurses involved family involved patients might help their loved ones. And then from this we stand and we created this industry rounds again just and then once we had those rounds. We started to talk about picks in those rounds, educate providers and other members of the medical team to kind of bring this to light. So you might not be surprised to look at how many patients can develop some of the emotional problems that we were talking. About 30% of survivors from the ICU develop depression, 70% develop anxiety, and about one third of the survivors develop PTSD, and the PTSD can be in the form of, um, they they've returned home and they start to develop a fever again. Or they start to develop a cough or their chest feels heavy and they're they're suddenly thrown back into the mindset of Oh my God, maybe I've got substance again. Do I have to go back to the I C U. What if I need to get that breathing tube and get help with my breathing from a ventilator? So So it's It's pretty intense. Some of the thoughts that they have we have, and we have had an ICU Survivor support group for probably 10 years. A nurse in the medical ICU named Jill Portwood started it with the support of Tina Greg, who was the head nurse manager at the time. And then different people, uh, joined to help co facilitate that group through the years and then maybe six months ago, knowing that the covid long hauler, um symptoms were similar to post ICU syndrome, Dr. Rosenberg asked if his patients could attend our support group. So would you. Thank you. So when we talk about what patients think of post ICU syndrome, this is what comes from our patients who have been in the I c U. They find that they're not the person that they were before, and they need to find out who they are again. The norm that they had previously in general is not there. And if we're not educating patients about changes that they might continue to experience, and I try to be careful with patients because I don't want them to feel like all is lost and you know they'll never you know, have any quality of life again. But I do try to a gentle way prepare them for the fact that this recovery journey may be a long journey, and some of the post ICU syndrome symptoms that they might experience are experienced by other people. Um, some patients recognize they have physical limitations, and so they realign their life and what they can do as a homemaker or a breadwinner. With that, um, people need to cope with the loss of what they were able to do before and what they're able to do. Now, Um, we had a patient come to our post ICU clinic a couple months ago who, um, had a very high level government job. And she said, because her thinking is slow now she needs some recovery. And actually, um, we did recommend for her to see an occupational therapy therapist who specializes in helping people get back to work when they have that slower thinking ability. Some patients feel shame and guilt because they made poor health choices. Maybe they didn't manage their diabetes, their hypertension. Maybe they drank too much or smoked or you know, any kind of a number of things. But then there's this regret of I sort of brought the sun myself, and, uh, that's where our spiritual directors can be helpful in helping them navigate some of those thoughts. Me, too. So, um, delirium is a big risk factor for patients developing post ICU syndrome, and this is something that we work with every day. So about 20 to 80% of the patients who are hospitalized, especially those in the I C U, can develop delirium, And so we encourage you to use the camp. I see you correctly, and that involves when your patients are at a negative 4-5 rests. That's the only time you can give them unable to assess that Uta. Otherwise, we do want you to notice. Do they have that fluctuating attention baseline, and either have the patient tap out the A for Save a Heart H e a r t or ask them The simple questions are, you know, do fish swim in the sea is £1 more than £2 and we had a lady in our post ICU clinic last week, and she's oriented and she's getting around. But she was hesitating on answering those questions, so detecting delirium is very important, so so that you can take the interventions that are going to help your patient with that. If we can prevent delirium, obviously that would be the most beneficial, you know, thing to do for our patient and so you know all of these interventions. But what I what I also would like you to commit to is making sure you go in the rooms and open those blinds or turn on the lights or, you know, talk to your patient to let them know where they're at. What happened? How did they get to be in this? I see you. What is this breathing machine doing for them before you suction? Tell them before you turn. Tell them that keeps their brain engaged, and it helps them make sense of where they're at. Because one of the gentlemen who came to our support group was in the medical I c u. He came in was emergent Lee intubated because he was covid positive, and it took him two weeks to realize where he was. And he said it was a respiratory therapist who took his head in his hands and said, You got covid. You're in the intensive care unit, you're safe, you're getting help with your breathing. But before that, he was thinking, like in the basement of some warehouse. I mean, the delirious thoughts that people get are pretty scary. Some of the other things that you want to do, especially for those of us who are doing frequent checks, frequent neuro checks, frequent vital signs. Can we collaborate with that medical team to reduce when we're doing those checks, You know, so that the patients can get some good sleep at night. So there's some other interventions here. I'm sure you know about them. But, um, I just want to make the point that, besides the nursing interventions that we do, it's also thinking along the medical lines of what else might be contributing to this delirium and getting those conditions treated. Um, blood glucose that's either too high or too low. Is the patients starting to develop a new infection? Um, is there other stress that's happening with them? Are we sedating them too much? We know that benzodiazepines can put a patient at risk for developing delirium. If you need that for your patient, can it be the lowest amount where the patients can still participate with physical therapy and then have less risk for continued delirium? And, you know, if you look at the literature, it's been said that delirium is an acute brain injury, so we just really want to either identify it and you know or reduce the occurrence of it. Um, risk factors for post ICU syndrome are many. Um, we generally talk about patients who are on the ventilator greater than three days, which are patients with ARDS patients with covid patients who have had severe substance, Um, patients who've had hypoxia, hypotension, um, and then those who are at great risk for developing delirium. Our patients who've had dementia or previous cognitive impairments. We know that there's two types of delirium hypo and hyper active. I think we're usually paying a lot of attention to the patients who are hyperactive trying to get out of bed. We want to keep them safe again. Try to find that sedation that can not overly sedate them. Let's just leave it at that. But actually, hypoactive delirium can occur more frequently, and it becomes and it stays undetected because if we're not looking for that wavering baseline of inattention and conducting the camp as we need to and not just putting you to in the, you know, evaluation, Um, then again, we might not be taking the measures that can help reduce the length of time someone has delirium. Um, just you know what patients look like with either kind of delirium? You know, the patients who are hyperactive because they're moving a lot? Um, you might want to find out what the patient is. Are you moving around? Because do they have pain? Are they nauseated? Do they not know where they're at versus the patients who are hyper have hypoactive delirium again? You want to ask questions, probing questions to them to try to engage their, um, cognitive ability? Yeah. Jan. So I think one of the big things that Jan talked about with delirium is we need to again intervene with our patients early. And even if the hyperactive delirium patients, you know, seem to be a pain, uh, sometimes moving is the best medicine for them to kind of keep that in the back of your mind. Uh, now we're in a kind of transition to talk about the a threat bundle again. This came out of society of clinical medicine in, like, 2000 10, I believe. Um, so this is kind of little diagram. I think we really try to instill within the U H system. Um, again, everyone is probably pretty familiar with the A threat bundle. Um, but we're gonna talk a little about it and see how we can. It can reduce post ICU syndrome. So how can we reduce delirium? Um, again? Very. Um can also be caused by lack of sleep, but also pain. I think we see correlation of patients who have uncontrolled pain, become restless, become agitated, don't sleep and then become full and delirious. We want to, like, dance that promote consciousness. So decrease sedation. We like to again wean event as much as possible so we don't have the oxidation on. And then we want to definitely increase your mobility. So I think overall are nice use at CMC. We've got a pretty nice job so far getting up patients on the ventilator earlier than we had been at least five or six years ago. Um, because obviously for PT helps get strength back, helps decrease length of stay for o. T. It helps them with increased participation in care. Um, which again can reduce the overall. So this one study showed that patients who exercised its not, uh, only 8.5% of patients who exercise got delirium or 21% of patients in the control group with no exercise got delirium. So the next slide, it really kind of illustrates how inactive are our patients. So this is a five year cohort study of over 3000 patients. Um, and these patients were specifically patients who their icy interstate was greater than 48 hours who were stable, he more dynamically stable. Still, about 50% of patients were not mobilized and did not get out of bed. And the General Consensus was that they look at the data, took 3.5 days to get patients after they were in the ICU out of bed. So it's kind of just again screens for the privatization of rehab, nursing the cloud, a thrift bundle model to get patients up and moving. So what do you know? Who does the hair bundle? Who does mobility again? Everyone's job this collaboration, and I think that's what we like a lot of us, like most about working the I C as we collaborate with everybody you know, nursing PT ot respiratory speech physicians. There's practitioners. Um, so again, it's kinda everyone's job is essential to conduct safe and effective or inability um So again, we try to communicate amongst all the team members against some of our units do rounding and rounding in the morning to actually set my ability goals for every patient every day. Um, and we actually use the common language. We have kind of adopted the icy mobility scale, Which is a 0-10 scale at CMC or through our system nurses Documentum ability on that scale and rehab recognized mobile unit scale as well. Then, of course, is Jann said we'd like to encourage our patients perform active active movements as if possible again. That's the range of motion. There is a place for it, but we definitely want it to be as active as possible. We can skip through this. That's okay. Yeah, Your diary. Okay. So besides, some of the things that, um, physical therapy, nursing, etcetera, um, as Mike mentioned before, Stephanie Cubic, one of our occupational therapist worked with a small group who to develop my ICU diary, and that's just about ready to come, um, into stores. So, um, and we're hoping to get the get the diary ordered by the head nurse Managers of our I C. U S but the diary is a place for the family to record. How did the patient come to the hospital? What some of the therapies have been that have been provided for the patient sort of and talk about the mobility goals, like, oh, today, you know, Miss Jones sat up in bed, You know, um, and gives a record. What we're hearing from our ICU support group is that patients sometimes because of how ill they were, they don't know what happened, and they want to know what happened. There's like a gap in their life, and so using the i c u diarrhea is helpful for that. Also, we have, um, patient education, patient and family education booklet called recovery Tips after an ICU stay. And often that's given to patients and families when they've gone to the floor and it goes over. Some of the basic things might talked about for families how they can encourage exercise while the patient is in bad. Because we make the point that patients shouldn't get out of bed without their nurse and goes through other things. Um, mental exercises, um, reducing stress, improving nutrition, having good sleep, and then the other educational material that we have is getting help for post intensive care syndrome again. It's a flyer that talks about what post intensive care syndrome is that we do have a clinic, that we do have a ICU support group and that, you know, using some of the interventions that families can provide will help with that. Yeah, so I kinda just fell up in the ICU diary then. We started using this about two years ago. Jan. Probably so. Hopefully in January. The new product going more strongly. Uh, with OT using the diary is an intervention. So as therapists, we and also nurses anybody. We like to use this as a part of our intervention because it helps the patients keep track of what's going on. It's everyone know this patient got to the chair yesterday. You know it's a two assists unless you know the family know that the patient, you know, everyone's involved with the care. So it's a quick case scenario that we had with the patient who really enjoyed the diary that one of our first patients we actually piloted it with as one of our long term patients with heart failure ended up needing a heart transplant. They had a pretty complicated post up course, including having a in fact, the left posterior parietal lobe. Also, Q kidney injury. So I got that multi organ system involvement. I got a high risk for picks. So the patient has been, wasn't in the I C for several weeks, actually made it out of the ICU into the floor. We kind of follow his patient along the whole way. Um, and kind of the patients feedback was pretty good. This is kind of against some of the first things we started to do. Just kind of what? How to make our diary better. So the patient's wife, right into him, uh, it helped him keep track of the days. So that's kind of one way they used it. Um, he liked to. He wanted to include pictures, so he wanted to put pictures of his family in there that was important to this patient. Um, he thought that it helps pay. The staff talked to him and stop and say, I didn't know that you were from this area, so I didn't know you had a dog. I didn't, you know, So kind of just gets the patients, especially if they're gonna be there for a while. Uh, getting the staff a little bit more personally, Um, we also put in there for this patient, some breathing exercises to help with anxiety that he because he was getting overwhelmed easily, and then he actually wrote it. He actually had. This is back when the therapy dogs who come around music therapy and they actually wrote a song together. And they actually put that in his diary. He had something he wanted to take with him. So definitely a pretty powerful tool. So, as we've said before, preventing post ICU syndrome or at least you know, having it be less intense begins with your work in the I c. U. And it's a team effort. Um, I think we've made that point several times here, 11, consult service that I haven't brought up was, um, psychiatry. So when we have patients that we need more help, um, for controlling either their delirium, aggressiveness. Some of our patients come to us, they're withdrawing from alcohol or some other medications and, you know, so we need their help, and they really can be very influential in terms of what they're recommending. I'm sure you are aware that there's really no drug that's FDA approved for treating delirium. We do give held all in small doses. At certain times. A land subpoenas another medication we use in certain indications. But we do have to be careful of any of the SS Ri drugs that we use. They typically prolonged Q T c and that can put the patient at risk for torso at the point where VT So the nursing interventions I really our number one thing and then reach for other drugs as you need to. We'll still meet. Okay, you know, the other thing is support family members. I'm sure you see these people at the bedside. They're so tense there, shaking. They don't know what to expect. So, as the nurse, you need to say to them, It's okay to go home. You need to eat. You need to take care of yourself. You need to take the medicines that you're supposed to be taking. We'll watch your loved one. You know, while you take care of you and have them contact their friends, church members, other family members and give those people a list of things that would truly help them. I see that some of the family members feel like I've got all the things at home and I'm taking, you know, being here with my spouse, and it's a lot. It's a heavy burden. So have them make, you know, have someone go through the grocery shopping, have someone pick the kids up from school, have someone you know mo the mobile on or whatever it is that's needed. But that way, when family or friends say anything you need, I'll get for you. They can give that list right off. We talked about helping families talk with the team. You know, sometimes I'll go in the room and the family members telling me now I'm not sure about this treatment or their treatment. I said, That's a good question for the doctor when the doctor comes around. Don't feel afraid to say that. So you really need to help support family members and bringing forth their thoughts. Are there worries? Just one? Yeah. Oh, wait. Sorry. Go back. Okay. So, um, we've already said survivorship of the ICU begins in the ICU, but this is a quote that I think is so powerful made by Mark Mickelson, millions of survivors are discharged into the community, unprepared and uneducated about what to expect and how best to cope, adjust and recover. And and that's why we developed and started the post ICU clinic. And I think, you know, um, Joe Portwood must have had some inherent thought about that, because before I see you, support groups were a thing. She had started one and then another quote by Brad Butcher. There's a sense of responsibility we should carry through the continuum of care that starts in the I. C. U through the outpatient setting to get the patient on the right path of recovery to help them find their former self. You think you're good? Uh, definitely. Quick, quickly touching. I'm kind of going off a chance. Points on some effects of critical innocent socioeconomic factors. Um, again, we kinda hit all the physical points, right? Mental points now just touching quickly on the social and economic factors. Um, So again, this kind of Study goes over a 12-month period, and over a quarter of patients report themselves still needing assistance and care again. Family members are severely affected. 80% of six months and 70% of 12 months. We're still acting as caregivers. Um, and that had a really negative effect on employment. Um, for this following discharge, almost 88% of patients reported seeing their primary care position, and 44% have seen a community nurse. So again, you think people follow up with a plan is not bad, but not everyone is following up. Um, mobility problems still nearly doubled between pre admission in six months. We kind of hit that over and over and again. Anxiety. Depression still is a big issue. Mhm. Yeah. So background of the picks clinic. Um, so we had our grand opening last June 2020 as CMC took us about two years to at least two years to kind of get up and running, um, securities to our group for that, Um, who are we? Um, we're Ahmad history team of PT ot nursing, respiratory, pharmacy, spiritual care, social work. And that's about it. So again, who are focused patients Again? Patients who are in the I.C. greater than 40 hours, 48 hours on the vent. People being treated for sepsis, RDS, respiratory failure and those who developed delirium. So that's kind of our criteria that have These patients have the highest risk for post ICU syndrome, and this is the patient population that we focus on. And our goal is to see patients every three months for the first year after discharge. So we've screened quite a few patients. Um, it's kind of labor, labor intensive experience, Um, educated quite a few patients. Um, this was for maybe two months ago, we had 38 patients who attended our, um, our clinic. And actually, our clinic is available on the 2nd and 4th Friday from eight till 12. So at most we can see four patients at a time because each clinic visit last two hours. Because we rotate the different disciplines, we have the patient in one room and we come and bring our expertise to our patients. Some of our patients on the day they're supposed to come cancel because, oh, they're supposed to have another surgery like in the next couple of days and, you know, they sort of lost track of that. They had their appointment. Some patients are actually recovering really well, and so they'll call and say I don't really need this appointment. I've been following up and I'm doing well. And obviously, if some of the patients that we screen because they are very critically ill have passed away or their goals of care have turned to hospital, hospice or palliative care, Mike already talked about who the disciplines are, um, in our clinic. What do we do so myself? As a clinical nurse specialist in Kelly Popovich, as a nurse practitioner perform physical assessment. We do adult risk screenings. We do some socio economic screenings like Is a patient feeling safe at home? Do they have enough money for food and paying utilities? Some of our patients need help with disability paperwork. Um, and we also screened for, um, PTSD, um, suicide anxiety, depression. So we use, um, validated and reliable scales for that. And then, along with our pharmacist, we conduct a medication reconciliation, and we found patients who had excuse me, duplication and medications medications that were started in the I C u like p p I. That really shouldn't have been continued. Like while they got discharged home. We recently had a patient who actually I can't remember if it was Mirabelle or one of our other pharmacists. The patient was taking a pics of bam once a day, and that's a twice a day drug that, if you don't take it twice a day, puts you at even greater risk for developing clots. So that was a super good catch, and we really kind of honed in on educating her about that. And then our respiratory therapist evaluates our patients through their medical record. If they if he needs to come, he will do some teaching and correct use of inhalers, other breathing techniques that are needed and then he'll advise us if he thinks the patient should have. PFD is done with a follow up appointment with a pulmonologist. Yeah, and then again, P. T no t c the patients as well. Uh oh. T focuses on self care tasks. Also managing, I think, at home as far as grocery shopping, paying bills, medication management, uh, any home safety issues we find. Sometimes our patients are getting home care, so we like the trenches them to outpatient therapy if they need, um and then Petey, obviously we assess more endurance because that's the thing. That's one of the biggest things that we see Post. I see we have a patient post lung transplant that we saw last week three plus months out of transplant and still couldn't do the stairs. So they definitely need to follow up with outpatient PT to work on that kind of strengthening. And we try and we get them things they can work on at home, um, to kind of work through, continue to get better. We just wanted to put a little graph together about the disciplines that are involved in our Cleveland Medical Center. It's the, um, column all the way over to the left. And how do we compare with other centers? Vanderbilt, Cleveland Clinic, University of Pennsylvania. We have a pretty strong, um, clinic. We are Requesting some administrative help and quality management help. But, um, you know, it's budget season, and we'll see if they can come through for us, but we compare quite favorably to other centers across the country. And actually, we are one of 37 medical centers in the world who has a post ICU clinic. So we're pretty proud of that. Um, we already talked about the criteria. Um, we wanted, uh, we ask our transitional care coordinators and our social workers, besides our physicians and our nurses to keep their eye open for patients that they think could benefit from coming to our post ICU clinic or attending our ICU Survivor Support group along with our covid patients. And then, if you have patients, you can ask the residents or your medical team to put in a referral. We have a referral for post ICU, um, recovery in the medical record and or you could contact myself any, actually, any of us. Um, if you just go ahead to them, you could contact any of us and say, I have a patient I'd like you to see. It doesn't have to be a patient who's already been discharged. If you identify a patient when they're in the I. C. U or on the floor and you see that they're struggling, you can, you know, contact any one of us, and we'll make a point to visit with that patient, assess them, even start giving them some interventions while they're, you know, on your floor in your I see you. So I'd like you to take a minute and fill in that I will statement and then do we have time to show our video? We have a short video. There is, um, a Facebook. I see a support group and this came from that support group. My name is Gary Merkel. On New Year's Eve 2019, I was airlifted to a hospital in Orlando, Florida, And I fell into Septic shock. And 107 days later, I came out of the hospital and I had lost all four of my limbs. Today it all begins. I'm seeing my life for the very first time through a different legs. Yesterday I didn't understand Driving 35 with the rocket inside. Didter't know what I had. While I've been waiting to live my life, I've been waiting on me. I'm gonna No, I'm gonna fly. I'm gonna know what it means to live and not just be alive. What's going on here? Because I'm gonna shop? No. Mm. And I will be dancing when circumstances drowned. Little music go. Yeah, Sale won't. Not enough. It's what I've been told. But it must be like a spirit Inside says so much more. So let them say what they want. Oh, I dare them to try. I'm I'm gonna die. Mhm. What it means to me just be left. Well, I got here is down on the show. Mhm, mhm. And I will be banned to it. Sir. Come stay on test drive music. Say I won't Sam. Sound Mm Fell along. I can do Christ. Who gives me It's okay to say no, That means all right. Just me. Yeah, go ahead. Whoa. Sure. Mhm until inside. Goons staking out Sam. Mhm. Mhm ship. Yeah. Sell. Yeah! Mhm. Mhm. This is for all of you, because this is what you do every day. So thank you. Yeah. Mhm. Good. Very nice presentation. Um, Jan, I wondered. So the cam is traditionally done. Be done. The i. C u. Do you see any place for it being done on the floors? Actually, there's a form of Cam called B cam. And there was a quality project just before covid. Um, where the B cam was introduced On what, 40 60. Do you remember Erin? 20 maybe. Might have been all tower six. And so the nurses started using it. And then there are the plans for rolling it out and education just kind of came to a halt when we had to deal with COVID. So I like that. I like your thought of that. And I do agree that we should be evaluating all our patients. Not just in the any other questions. Any I will. Statements. There is a question. Is the clinic covered by insurance? Yes. And actually, um, when we have patients that have an appointment scheduled The secretary from PT ot um contacts insurance to make sure that the patients will be covered. So thank you for that question. Hi. Hi. It sounds like you're focused on the patients at CMC for the picks clinic. What about for the community hospitals? Is there a way to get get a referral? Sure. I mean, contact us. Yeah. I mean, our clinic is obviously because we work at CMC. Those are the patients that we see and can evaluate and bring to our clinic. But we would be open to having other patients. Actually, Dr Rosenberg sent a patient from his covid clinic to us because he felt like he wanted the multidisciplinary evaluations to be done. And we've sent patients to his clinic because we've had patients in our ICU with covid, and they need that palm analogy follow up. So, yes. Um, this question is more based on, like, mobility for Mike. You know what they did in trauma where they had the dedicated physical therapists? Are they considering doing stuff like that and all the units? Because that was extremely helpful. Yes, actually, as of this year, all that, you must have a dedicated therapist. Yeah, there's definitely interest from the chat, um, from the community, in terms of getting people you know, into the picks clinic. As we as we as we grow our numbers and can demonstrate that there is a need for us to add personnel to have longer, um, clinic dates and times, we'll be able to accommodate more people. And I mean, there have been suggestions that should other entities in the U. H system have, um, a post ICU clinic, which which would be fine. So we would be happy to help anyone figure out what what it is that's needed to open a clinic Created by
