Pioneers in patient care: consultants leading change
North West
Innovation: Pioneered intensive care aftercare – a follow-up, support and rehabilitation programme for patients who have spent time in intensive care
Dr Richard Griffiths
Whiston Hospital and University of Liverpool
Job title: Reader in medicine (intensive care)
Specialty: Intensive care medicine
“Intensive care patients often lack an autobiography of their illness and this can severely compromise their recovery and encourage psychological disturbances,” says Dr Griffiths.
He says: ‘This aftercare system involves the follow up and support of patients by intensive care doctors and nurses following their stay on the intensive care unit. We can tell them what happened when they often have no memory. It enables patients to understand their illness and recovery and doctors and nurses to provide better care.
“The framework provides immediate support to wards after discharge and later a clinic outpatient programme. It allows patients to regain their independence and responsibility for their health following a severe illness of which they usually have no recall.
Dr Griffiths says: “It was introduced because there was no formal follow-up or care programme that addressed a patient’s recovery phase following a critical illness. Nothing was available to address some of the unique features that we have described. Often the multi-system disorders and cognitive disturbances that occur in these patients may be far removed from the primary problem that was responsible for their admission. Our research identified problems that were going unrecognised.”
Dr Griffiths says: “The research programme began 11 years ago. But in the last four years it has been more widely accepted and many more intensive care units now provide such a service. The Audit Commission identified it as a quality standard and now it forms a recommendation in the recent NHS guidance on comprehensive critical care.
The programme was initially funded through research programmes from the Mersey region, The Sir Jules Thorn Charitable Trust and The Stanley Thomas Johnson Foundation (Geneva). It is now incorporated within clinical service budgets.
Dr Griffiths says: “We try not to let patients down. Our greatest problem is the current hospital crisis where the number of patients we treat has fallen due to the inability to discharge patients. Within the acute hospital sector everything must be done under pressure so that compromises have to be made.
“We have worked for many years to establish a well equipped and staffed intensive care unit to the standard we desire and now our problems are less compared to other areas of the hospital service. Intensive care is dependent on hospital activity. The most important issue is that throughput and patient expectations do not match overall funding.
However Dr Griffiths says his innovations have been encouraged and supported by his trust. “I am proud to be working in one of the first NHS trusts that has always had close relationships with management. Intensive care doctors have provided the medical directorships of our trust. Quality comes at a price and we could always do better with more resources. The increased spending over the last 10 years has just kept pace with changing demographics and the increased elderly population.”