Rehabilitation after critical illness: summary of NICE guidanceBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b822 (Published 25 March 2009) Cite this as: BMJ 2009;338:b822
- Toni Tan, technical analyst1,
- Stephen J Brett, consultant in intensive care medicine2,
- Tim Stokes, associate director1
- on behalf of the Guideline Development Group
- 1Centre for Clinical Practice, National Institute for Health and Clinical Excellence, Manchester M1 4BD
- 2Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
- Correspondence to: S Brett
Why read this summary?
More than 110 000 people are admitted to critical care units in England and Wales each year,1 of whom 75% survive to be discharged home. Many of these people experience considerable and persistent problems with physical, non-physical, and social functioning after discharge from critical care. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on rehabilitation after critical illness for adult general critical care patients.2
NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice and, in this guidance, also from lessons that can be derived from other clinically relevant fields of patient care. Evidence levels for the recommendations are given in italic in square brackets.
Key principles of care
To ensure continuity of care, healthcare professionals with the appropriate competencies should coordinate the patient’s rehabilitation care pathway. The healthcare professionals may be from intensive care or other services (including specialist rehabilitation medicine services) that have access to referral pathways and medical support (if not medically qualified). Key objectives of the coordination are:
To ensure that rehabilitation goals are reviewed, agreed, and updated throughout the patient’s rehabilitation care pathway
To ensure delivery and support of the structured and supported self directed rehabilitation manual (a specific type of rehabilitation programme),3 when applicable
To ensure that information, including documentation, is communicated to other relevant hospitals and to other rehabilitation services and primary care services
To ensure that patients have the contact details of the coordinating healthcare professional(s) on discharge from critical care and again on discharge from hospital.
[All the above recommendations are based on the experience and opinion of the Guideline Development Group (GDG)]
During the critical care stay
Perform a short clinical assessment to determine …