Anaesthesia, Critical Care and Pain Medicine

SCARF Supporting Community Recovery and Reducing Readmission Risk Following Critical Illness

The project James and Eddie will launch, along with a wide range of partners, aims to collaborate with and build on the work of the award-winning NHS Lothian Patient Experience and Anticipatory Care Plan Team (PACT) which reduced unplanned hospital admissions by over 30% for the high risk cohort of patients.

General Background: The Experience of ICU Survivors

People requiring admission to an intensive care unit (ICU) following a critical illness often leave hospital with multiple health and social care needs.

These ‘ICU survivors’ can experience significant clinical problems that affect them physically and psychologically. They may also face social problems such as employment, financial and family stresses. Consequently, many ICU survivors require significant support from community health and social care services. Family members and carers of ICU survivors may also require support from health and social care services given the stressfulness of their own experience.

The vast majority of ICU survivors look forward to getting home and recovering in familiar family surroundings. However if the right type of support from health and social care services is not forthcoming, their recovery can be negatively affected and they can end up back in hospital.

Research Involving ICU Survivors in Scotland

Researchers based at Edinburgh University’s Critical Care Research Group have been conducting research on ICU survivorship for over a decade. One recent research project on ICU survivors in Scotland found that 25% had had an early-unplanned hospital readmission to an acute bed within 90 days of their discharge home. A very high level.

Other research has identified key patient-centred factors (mobility problems, polypharmacy, fragile social support, multi-morbidity, mental illness and social deprivation) and key system-wide health care factors (poor discharge practices, slow communication across acute and primary care and medication error) that negatively affect ICU survivors’ community recovery and increases their risk of early-unplanned hospital readmission.

Over the last year, we have met with various health and social care groups in Lothian and Scotland to share learning and build partnerships to address ICU survivors’ recovery needs.

Using Research to Improve Practice: Our Successful Grant Award

Against this backdrop, members of the Edinburgh Critical Care Research Group, along with our partners, applied for and have been awarded a health improvement grant from the iHub Improvement Fund for a NHS Lothian wide health improvement project to better support recovery of ICU survivors and reduce their risk of early unplanned hospital readmission.

This unique multi-disciplinary and anticipatory care initiative will involve NHS Lothian, Edinburgh Health and Social Care Partnership, Midlothian Health and Social Care Partnership, Community Pharmacy Scotland, VOCAL (Voice of Carers across Lothian) and Carr Gomm (an Edinburgh based social prescribing group). Our project starts on 1st March and will last for 15 months.

The funding will go towards supporting the work of the project’s Principle Lead Dr Jim Marple a GP and Quality Improvement Fellow, and its Project Manager Dr Eddie Donaghy. It will also support critical care nursing staff to identify ICU patients’ most at risk of hospital readmission and to assess their key health and social care needs before and after their discharge home. We will be working closely with the above partners to improve ICU survivors’ recovery journey in general and, in particular, of those most at risk of early-unplanned readmission.

Dr James Marple and Dr Eddie Donaghy
Dr James Marple (Project Lead) and Dr Eddie Donaghy (Project Manager)

One of the project’s key aims is to reduce early-unplanned hospital readmissions of ICU survivors in Lothian by 20% over the course of the project.

We will also conduct an evaluation of the project from the perspective of ICU survivors, their carers/family members and participating health and social care staff. Evaluation findings and learning from the project will be used to improve practice, and be shared across NHS Scotland.

iHub Improvement Fund