1. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE)
Results and Findings

2. What were we trying to achieve?
Improved Quality of Life in this group
Empower patient to take control of their health and wellbeing
Increase Return to Employment by 20%
Decrease GP visitation by 20%
Patient Satisfaction

3. EQ-5D
(Quality of Life)

4. How did we measure impact?
Historical control group ( )
Similar follow up dates to our population (One to two year post ICU discharge).

5. Patient Empowerment Generalised self-efficacy tool
The scale ranges from (10 lowest possible self-efficacy and 40 being highest achievable score)
Self-efficacy measurements were undertaken at baseline (start of clinic), week 5 of the clinic at six months and at 12 months.
Important Concept: We know that Self Efficacy is related to QoL.

6. Increase Return to Employment by 20%
Again, Historical control group
Who got back to work at one year?

7. Decrease GP visitation by 20%
How many patients regularly had contact with their GP at one year
Within one cohort, it became apparent that we were increasing GP visitations!
Empowerment
Did we improve the quality of visits?

8. Patient Satisfaction Undertaking qualitative interviews
Purposive sampling
11 patients and caregivers at 6 months
Thematic analysis utilised

9. Statistical analysis R (Version 3.3.0) for statistical analysis .
Continuous variables were expressed as medians and inter quartile ranges and analysed using the Mann-Whitney U test
Categorical variables were compared using chi squared tests  
All tests were two sided and a p value of less than 0.05 was considered significant
Multi- variable regression to adjust for differences between the groups (historical control vs. InS:PIRE cohort).

10. 48 patients took part in InS:PIRE over the one year learning period
2 patients ≥65 years and excluded from analysis
2 patients passed away in the follow up period
1 patient new diagnosis of cancer and did not want to continue with programme
2 of these patients had alcohol dependency
3 patients did not complete EQ 5D at one year
40 patients at one year analysed
87%
follow up rate

11. Patients Patient Characteristic n=46 Gender (Male, %) 65.2%
Age (years, median, IQR)
51 (43-57)
ICU LOS (days, median, IQR)
15 (9-26)
APACHE II (median, IQR)
23 (18-27)
Charlson Co-Morbidity Index (median, IQR)
1 (0-2)
Patients with Mental Health Problems Pre ICU (%)
45.7
SIMD Decile (median, IQR)
3 (1-4)
Hospital LOS (days, median, IQR)
47 (24-80)
Proportion Ventilated (%)
93.5
Proportion undergoing RRT (%)
34.8
Proportion undergoing CVS (%)
Employed Pre-ICU admission (%)
41.3
Retired Pre-ICU (%)
10.9
Unemployed Pre-ICU (%)
43.5
HUS Clinic Baseline (median, IQR)
0.364 ( )
HUS One Year (median, IQR)
0.620 ( )

12. Self Efficacy
Baseline median of SE 25.5 (IQR ) to 28.5 (IQR ) at five weeks (p=0.003).
This was sustained at one year post InS:PIRE- median SE score of 29 (IQR 26-32).

13. Quality of Life (QoL)
Compared the historical control group and the InS:PIRE cohort
Working age population only.

14. InS:PIRE cohort vs. Historical control Patient Characteristic
InS:PIRE cohort (n=46)
Historical Control
(n=53)
p value
Gender (male %)
65.2
58.5
0.63
Age (years, median, IQR)
51 (43-57)
47 (40-52)
0.16
ICU LOS (days, median, IQR)
15 (9-26)
3 (1-10)
<0.001
APACHE II (median, IQR)
23 (18-27)
14 (9-19)
Charlson Co-Morbidity Index (median, IQR)
1 (0-2)
0 (0-2)
0.35
Patients with Mental Health Problems Pre ICU (%)
45.7
39.6
0.69
SIMD Decile (median, IQR)
3 (1-4)
2 (1-5)
0.31
Hospital LOS (days, median, IQR)
47 (24-80)
25 (11-50)
0.002
Proportion Ventilated (%)
93.5
79.2
0.12
Proportion undergoing RRT (%)
34.8
13.2
0.03
Proportion undergoing CVS (%)
17.0
0.005
Employed Pre-ICU admission (%)
41.3
47.2
0.07
HUS (Median, IQR)
0.620 ( )
0.516 ( )
0.26

15. Multivariable regression
Factors that impact recovery
Charlson Co- morbidity
SIMD
Work Pre-ICU

16. Multivariable Analysis
For those who undertook the InS:PIRE programme there was a significant increase in their HUS after adjustment for social factors pre ICU (SIMD, Charlson Co-morbidity, in work pre-ICU) (0.16; 95% CI ; p=0.04)
Variable Estimate
p value
Charlson Score
-0.06 ( )
0.024
SIMD decile
0.03 ( )
0.017
Working Pre ICU
0.18 ( )

17. Qualitative analysis Support Psychological Impact Physical Impact
Future Direction
Patient volunteers provided hope, optimism and peer support.
Understanding of symptoms and coping mechanisms
Increased confidence and independence
Longer time/balance of dependency
Staff (MDT) – cohesive approach
Family benefit
Use of goals/personal goals
Importance of follow up
Created a community
Feeling normal, acknowledgement of illness
Importance of involving carers

18. Support-Patient Volunteers
‘It’s good to see how far somebody who has been so ill like yourself can improve and recover over a period of time.’

19. Psychological Impact- Feeling Normal
‘..it was so good to know that you were normal. I didn’t feel like an abnormal person anymore, I felt like everything I was feeling was a normal reaction.’

20. Physical Impact- Goal Setting
‘I was nervous in case I didn’t achieve them and then coming back today to realise that I have actually overachieved a couple….it was a good thing because I would not have set goals for myself’.

21. Return To Work Pre ICU 17 of the 40 patients employed pre ICU (42.5%)
4 retired (10%)
19 unemployed/chronically unwell pre ICU(47.5%)
Post InS:PIRE
8 patients returned to employment or volunteering roles after ICU (71%) vs 64% in historical control group.
One patient voluntarily retired (2.5%)
Those who weren’t in work pre ICU, 3 (7.5%) in volunteering roles.

23. Limitations Single entre Small sample- not powered
Learning project- patients at different stages of recovery trajectory

24. Conclusion
InS:PIRE is a safe, appropriate, person centred programme which patients and caregivers feel is beneficial
Over the five weeks of InS:PIRE, patients felt more in control of their health and wellbeing
Those patients who have undergone the InS:PIRE programme appear to have a significantly better QoL than those patients who have not.

25. Thanks! Health Foundation Health and Social Care Alliance
Citizens Advice Bureau (Maryhill and Possilpark)
Glasgow Council for the Voluntary Sector (GVCS)
Carers Centre (NHS GG&C and Glasgow City Council)
Quality Unit at the Scottish Government
All the patients who took part

26. We enjoyed last Thursday, we miss coming up to see you all
We enjoyed last Thursday, we miss coming up to see you all. Thanks for giving us our lives back Liz x