New support group for intensive care survivors and their families

Dr Samantha Perera [pictured below, left-hand side], a psychiatrist working with the South London and Maudsley NHS Foundation Trust, and Sian Saha [pictured below, right-hand side], senior research nurse in the asset research team at King’s College Hospital NHS Foundation Trust which covers the anaesthetics, critical care, emergency and trauma departments (ACET), share their experiences working together to establish a patient and family support group for intensive care unit (ICU) survivors.

Sam and SianExperiencing a critical illness and admission to an ICU is widely recognised as having a powerful psychological impact on patients and their families. Offering patients continuing psychological and physical support during recovery is vital. We spoke with Dr Samantha Perera and Sian Saha who set up a psychological recovery group to support ICU survivors and their families at King’s College Hospital NHS Foundation Trust. They tell us about their ambition to continue the service beyond the current pandemic.

Sam and Sian, please describe your roles at King’s Health Partners.

Sian: I’m a senior research nurse in ACET at King’s College Hospital NHS Foundation Trust and a fellow at the National Institute for Health Research (NIHR). 50% of my time is spent delivering research at the Trust and 50% is spent working on my NIHR fellowship. During the first few months of the COVID-19 pandemic I was redeployed to the King’s College Hospital NHS Foundation ICU.

Sam: I’m a psychiatrist currently working in my hometown of Brighton with Sussex Partnership NHS Foundation Trust and spending one day a week with the South London and Maudsley NHS Foundation Trust’s Department of Psychological Medicine based in King’s College Hospital. Having trained at South London and Maudsley NHS Foundation Trust, and worked there for a number of years, I feel very much connected to the Trust, so I got in touch with colleagues to come back a day a week to develop this new service. Setting up the psychological recovery group with colleagues at King’s College Hospital and the Department of Psychological Medicine was a really meaningful way for me to give back to the King’s Health Partners community.

How do the support group and weekly sessions operate?

Sam: Currently, we are running the group for ICU survivors and their families online. It takes place every Thursday at 2pm and lasts one hour. The group is facilitated by both Sian and myself. For the first five minutes we all do some exercises guided by our physiotherapy colleagues. These sorts of exercises are really important for ICU patients as we know that 25% of ICU survivors display significant muscle weakness, and 90% will have ongoing muscle weakness. After settling in with these exercises we use the next 50 minutes of the session for patients and their families to share their experiences of ICUs and reflect on how they are doing now. These conversations can be extremely powerful and include thinking about potentially traumatic experiences during severe illness. We spend the  last five minutes doing breathing or grounding techniques. This helps people check out of the group safely. 

Sian: These sessions can bring up a lot of distressing subjects and experiences. While the session is running, Sam or I monitor what is going on in the virtual room. For example, if there is someone who seems particularly quiet, we may encourage them to talk about their experiences. Alternatively, if anyone appears distressed, or leaves the group, we follow up with them after the meeting to make sure they are ok and if there is any additional support needed.

Sam: These sessions can be emotional for patients and staff.  Ensuring high quality supervision and debriefs for the staff facilitators is really important. Our colleagues from the Department of Psychological Medicine and the Centre for Anxiety Disorders and Trauma have worked with us to add in this structure and provide training and a reflective space to help us both process and facilitate the group safely and well.

Where did the idea for a support group come from?

Sam: During the first few weeks of the pandemic, my colleagues and I reached out to one another to check how we all are doing and coping.

As the pandemic progressed and worsened, it got me thinking in particular about patients being cared for in ICUs, across all UK hospitals, and the psychological impact. Imagine waking up in an ICU with all the machines whirring and staff dressed in personal protective equipment. You cannot see your family and have no idea about what is happening outside the hospital doors, plus you are seriously unwell.

That is when I thought we need to think about a support group for these patients, to talk about their experiences as and when they start recovering from ICU. I reached out to anaesthetic colleagues, like Sian, and they were very supportive about the proposal and keen to get involved. The group had been something critical care had wanted to set up for years, not just during the pandemic.

Personally, I was also really determined that we created a group that would be truly inclusive. The disproportionate impact that COVID-19 has had on people from Black, Asian and Minority Ethnic (BAME) communities has shown all of us how much harder we have to try to address these shameful inequalities. The Black Lives Matter civil rights movement made me really reflect on my role as a doctor. The majority of my post graduate training thus far has been in south London, a population with a large BAME community; it felt only right that I give back to this community who has taught me so much.

On which model did you design the support group?

Sian: One thing recommended in the National Institute for Health and Care Excellence (NICE) guidelines is providing support groups for patients who have spent a long time being cared for in hospital. Even though we have an excellent follow-up clinic for patients at King’s College Hospital NHS Foundation Trust, we had not yet set up this type of recommended support group for patients.

Our King’s Health Partners’ partner, Guy’s and St Thomas’ NHS Foundation Trust, had a similar support group, so Sam and I attended a meeting over there and asked a lot of questions about how it was set up.

Sam: We really must thank Dr Joel Meyer, critical care consultant at St Thomas' Hospital, for his invaluable advice. He started his model two years ago and it is amazing to see the difference it has made and how beneficial his patients found it. When I  oined one of their groups it was incredibly moving. Patients at the end of the session said to me – “so you’ll be running something like this at King’s College Hospital NHS Foundation Trust, then?” That gave me the energy to make sure our group got off the ground. 

How are patients recommended to the service?

Sam: Suitable patients attending COVID-19 follow-up clinics will be given information about our group. However, our group is not just for patients who have had COVID-19, it is for anyone that was admitted to ICU at any time. We also have information on the King's College Hospital NHS Foundation Trust critical care page and a Twitter account (@KingsICUSupport) which we hope these patients may see. Publications like this will also help get our name out there!

Sian: Once we have the names of potential patients who would like to attend, we look at the electronic patient record and check that they are suitable for the service, taking note of their mental and physical health before we invite them to the meetings. It is currently a small service, but growing week by week!

How has the service benefitted from partnership working?

Sam: Having connections across both Trusts (South London and Maudsley and King’s College Hospital NHS Foundation Trusts) was really critical. This is a true mind and body intervention that we could not have done without the wide expertise across both organisations. 

What staff benefits have you seen?

Sian: The positive feedback from patients about the service has really boosted staff morale working during the pandemic.

It is such a difficult time and staff and our colleagues are all working so hard to care for patients. Once a patient moves on, or is discharged from an ICU, staff might not know what happens to them. Hearing how our patients are continued to be supported means everything to staff. For us to just be able to come back to colleagues and say to them, we have just had a conversation with someone you looked after a few weeks or months ago, boosts the mood at a time when everybody really needs it.

The King’s Health Partners Mind & Body programme is committed to joining up mental and physical healthcare, training and research to improve health outcomes for our patients and service users. Find out more about the important work we are doing.

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