Professor hopes major report will lead to improved rehabilitation for critical care patients

A professor from University Hospitals Coventry and Warwickshire (UHCW) NHS Trust who has led the largest ever national enquiry into rehabilitation outcomes for critical care patients is hoping its report will lead to a major change in how care is delivered in the UK.

For the past two years, David McWilliams, Professor of Critical Care and Rehabilitation, has led the study on behalf of the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD).

Healthcare records were reviewed for more than 1,000 adult patients who were admitted as an emergency to an intensive care unit (ICU) for four or more days in the last three months of 2022 and later discharged from hospital, along with hundreds of responses from NHS trusts, clinicians and healthcare professionals.

The report, Recovery Beyond Survival, highlights the need for organisations to recognise the importance of rehabilitation, not just within ICUs but across all specialty areas, wards and in the community.

Its recommendations include the need to:

• improve the co-ordination and delivery of rehabilitation following critical illness at both an organisational level and at a patient level;
• ensure that multidisciplinary teams are in place to deliver the required level of rehabilitation in ICUs and across the recovery pathway; and
• provide patients and their family or carers with clear information about their admission to an ICU, impact of critical illness and the likely trajectory of recovery.

Professor McWilliams, who works between UHCW NHS Trust and the Centre for Care Excellence at Coventry University, said the study came about following concerns about inconsistencies in the quality of rehabilitation provision regionally and nationally.

“When patients are first admitted to an ITU, the prime focus understandably is on medical stabilisation and saving their life,” he explained. “What people often don’t realise is that during this period patients lose a lot of muscle due to bed rest and inactivity. As a result, people who survive critical illness are often left with significant physical, psychological and cognitive morbidity which can last months or even years after they leave hospital.

“This has a significant impact on people’s overall recovery, with less than half of people returning to work 12 months after leaving hospital and around one in three still needing help with day-today activities.”

The report highlights areas of excellent practice and provides guidance to support rehabilitation needs within ICUs, hospital wards and the community and to improve care and outcomes for patients and their families.

Professor McWilliams added: “The recommendations are aimed at everyone who is involved in funding or delivering care for people recovering after critical illness. The report is a really good tool to start to deliver improved care and services for patients who desperately need it and I’m hoping it will lead to some major changes nationally in the way we deliver care.”

He will be speaking about the study at national keynote presentations over the next few months, including to 1,000 delegates at the Intensive Care Society’s* State of the Art (SOA25) Congress in Birmingham in July.

*Professor McWilliams is Chair of the ICS National Rehabilitation Collaborative