Rehabilitation long-term phase

This classification is a useful distinction that can be applied to the conceptual rehabilitation model and framework (Figs. 4 and 5). The core ICU team undertakes the acute and intermediate phase of nonspecialized rehabilitation. The long-term phase is specialized rehabilitation and again undertaken by the core ICU team but in collaboration with other relevant specialist practitioners, such as speech and language and occupational therapy, to optimize the patients rehabilitation potential. 

Figure 4 shows a conceptual model that encompasses the phases of the patient s potential journey through ICU. Inevitably, these phases overlap. As the LOS increases there are greater risks of secondary infections and acute events that require management. Therefore, the intermediate or long-term phases pause, although rehabilitation should never be stopped, but... 

This framework embraces the concept of whole-body rehabilitation, as described by Martin et al. (17), including physical and psychological aspects of care during the ICU stay. An essential component is the appointment of a coordinator, particularly in the intermediate and long-term phases, to ensure continuity and consistency. In the United Kingdom, the PT and nurse in the ICU are in a prime position to take on such a role. 

Following implementation of the long-term phase of the rehabilitation framework, she was weaned and decannulated within 21 days. Her total LOS in the ICU was 106 days at a cost of 159,000 ( 301,221). She was transferred to the ward and went home 14 days later on an individual pulmonary rehabilitation program. At six months Sarah was back at work full time and has had no further physiological or psychological problems. Appendix 1 shows Sarah s specific rehabilitation and weaning plan. 

Table 3 Sarah s Weaning Episodes Prior to Commencing the Long-Term Phase of the Rehabilitation Framework...

Figure 7 PS level following implementation of the long-term phase of the rehabilitation framework. Abbreviation PS, pressure support.

Once Sarah was placed into the long-term phase of the rehabilitation framework, all active weaning from MV was stopped and the nurse consultant, the lead doctor, and the PT made a comprehensive and holistic assessment. Further advice was sought from the dietician, the speech and language therapist, and the pharmacist. An overall plan was then developed, which included the following ... 

Stage Three Continuing Care. After the rehabilitation phase, the patient enters a period of continuing care. At this point, treatment often transitions to community resources such as self-help groups. In many cases, continuing care patients move beyond the need for intensive psychiatric treatment but continue to require the support of others as they move through the long-term recovery process. 

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