Clinicians are facing up to the preventable harms that ICU’s inflict on many patients in the process of saving lives

Doctors and hospitals finally are owning up to and treating mental and physical damages inflicted on some of the sickest and most vulnerable individuals in their care—the 5 million or so patients who get helped in intensive care units, published research shows.

Although ICU patients may get dramatic emergency care that saves them from deadly infections, major disease, and significant accident or injury, experts only recently have begun to recognize and assist them with a condition associated with their stays: post-intensive care syndrome (PICS). A readable new study in the medical journal JAMA says that ICU patients may suffer a “constellation of symptoms” with PICS that hinders their recovery to their pre-hospitalization well-being, including: “muscle weakness, cognitive impairment, depression, anxiety, and post-traumatic stress disorder (PTSD).”

Medical specialists at 21 hospital systems nationwide have created a collaborative they call THRIVE to better assist and support PICS patients and figure with solid research evidence how medicine can reduce its ICU harms.

The condition is everywhere. THRIVE centers report that as many as 8 of 10 of ICU patients studied reported cognitive impairment and 6 in 10 suffering depression. One ICU recovery center found that “Patients also had high rates of physical disability … 44 percent were unable to complete a six-minute walk test and only 15 percent had returned to work. Anxiety (37 percent) and depression (27 percent) were also common, and PTSD occurred in 5 percent of its patients.”

Caregivers say that PICS patients also may be tormented with vivid dreams and delusions in the ICU and these may haunt some long after discharge. Hospitals have created diaries to log patients’ ICU stays in simple, direct language to help them understand their care and fill memory gaps. As researchers noted in JAMA: “Studies have shown that this approach can reduce PTSD. For example, one woman had visions of being trapped under snow during her ICU stay. She was reassured to learn she’d experienced a high fever and that her clinicians used ice packs to help bring the fever down.”

Assisting PICS patients may require not only specialized clinics or centers for them but also expert teams, including doctors specializing in caring for the critically ill, pharmacists, nurses, psychologists, and social service caseworkers, as well as heavy involvement of primary care physicians.

Patients need and appreciate the intensive and comprehensive help that teams can give them, not only as they recover from the medical situations that put them in ICUs but also so they receive the physical and psychological therapies they may need for PICS. Connecting patients to available resources can be both helpful and game changing for them, as they may have spent, with insurance coverage to some degree, huge sums on their care already and they may not know where to turn next.

In my practice, I see the harms that patients suffer while seeking medical services, including the traumatizing effects of hospitalization itself, especially in ICUs. A body of research is growing about how noisy, disruptive, and scary hospitals can be, and how their 24/7 care, including rounding and repeated status checks (temperature, pulse, blood pressure and more), not to mention much criticized food services, may keep patients hungry, sleep-deprived, and hard-pressed to get better faster. It only makes sense that the negatives of modern medical care—rooms too bright to rest in and filled with beeping machinery, as well as with medical staff coming and going—increase exponentially in ICUs.

Patients and families, while they welcome and are grateful for intensive medical care, can find it intimidating. A dad and lawyer, experienced in dealing with stressful situations, has told a colleague that he was both terrified and awe-struck by his son’s weeks in an ICU after a car wreck. And if seeing a loved one hooked up to batteries of advanced equipment, with platoons of skilled caregivers rolling in and out of an ICU room all through the day and night, may seem a lot to bear, imagine the effects patients themselves may register, even in twilight states. Let’s not forget that in 1 or 2 of every 1,000 procedures, with anesthesia, patients may not experience pain but may be aware and conscious to some degree.

In the meantime, doctors and hospitals also have been put under increasing pressure by lawmakers, regulators, and safety advocates to both transition patients faster out of their expensive care (and especially into nursing homes), while also ensuring this occurs in optimal ways—without boomerang, bounce-back or otherwise excessive and too swift readmissions. Experts have pored over ways to improve discharge and transition processes, working with patients and their loved ones to ensure they understand medications and therapies that will be needed after a hospitalization to ensure recovery.

PICS patients may have experienced extremes in medical care, but they also may have invaluable insights to offer on how doctors and hospitals can improve what and how they do now.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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