ICU Survivors’ Follow up: Burden of Post Intensive Care Syndrome on Critical Care Unit and Family

INTRODUCTION: Care of the ICU survivor after discharge is challenging. Many of the survivors are discharged with disabilities; and they are often discharged with indwellings. Post-intensive Care Syndrome – Family (PICS-F) is a myriad of physical and psychological burden encountered by the family of the ICU survivor. Due to the lack of a dedicated follow up unit, the follow up visits of the ICU survivors also impart a direct burden on the health care system. PICS-F as well as the burden on the health care system caused by the follow up visits of the ICU survivors are underinvestigated. OBJECTIVES: To assess the physical, psychological and financial burden of the care of the ICU survivors on family. To assess the burden of the follow up visits on health care system. To study the factors that affect the family and the health care system. MATERIALS AND METHODS: Our study is a single centric, prospective observational study. ICU survivors fulfilling the following criteria are included consecutively: INCLUSION CRITERIA: Age ≥ 18 years. ICU stay ≥7 days. Discharge Cerebral Performance Category Scale (CPCS) score of ≤ 4. EXCLUSION CRITERIA: Discharged against medical advice. Transferred to other facility for continuation of treatment. THREE PRIMARY OUTCOMES WERE STUDIED: Burden of PICS-F is studied by a validated tool namely CDC HRQoL-14 Questionnaire. Financial burden on the family is studied by total expenditure in 2 months post discharge period. Burden on the health care is studied by a novel index namely ‘the Man-Time Index’ (MTI). A few factors are identified, for e.g. Discharge CPCSS and Indwellings at the time of discharge, and their influences on the burden on the family and the health care system are investigated. RESULTS: A total of 30 survivors of median age 38.5 years (18-76 years), 50% males were included. Median unhealthy days, based on HRQoL-14, for CPCSS 1–2 and CPCSS 3–4 were 12 days and 19.5 days, respectively (p<0.05). Discharge CPCSS 1–2 vs CPCSS 3–4 showed 2 months’ expenditure of Rs. 39,000 vs Rs. 79,000 (p<0.001). Patients discharged with no indwellings vs with indwellings revealed median MTI of 25 man-minutes vs 200 man-minutes (p <0.001). Discharge CPCSS 1–2 vs CPCSS 3–4 showed median MTI of 76 man-minutes vs 82 man-minutes (p<0.05). CONCLUSIONS: Discharge CPCSS affects PICS-F and contributes significant financial burden on family of the survivor and on the health care system. Discharge with indwellings increases the burden on the critical care unit during follow-up visits.