Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference Dale M. Needham, MD, PhD; Judy Davidson, DNP, RN; Henry Cohen, PharmD; Ramona O. Hopkins, PhD; Craig Weinert, MD, MPH; Hannah Wunsch, MD, MSc; Christine Zawistowski, MD; Anita Bemis-Dougherty, PT, DPT; Susan C. Berney, PT, PhD; O. Joseph Bienvenu, MD, PhD; Susan L. Brady, MS; Martin B. Brodsky, PhD; Linda Denehy, PT, PhD; Doug Elliott, RN, PhD; Carl Flatley, DDS; Andrea L. Harabin, PhD; Christina Jones, RN, PhD; Deborah Louis, RN; Wendy Meltzer, JD; Sean R. Muldoon, MD, MPH, MS; Jeffrey B. Palmer, MD; Christiane Perme, PT, CCS; Marla Robinson, OTR/L, MSc, BCPR; David M. Schmidt, MD, PhD; Elizabeth Scruth, RN; Gayle R. Spill, MD; C. Porter Storey, MD; Marta Render, MD; John Votto, DO; Maurene A. Harvey, RN, MPH, FCCM From the OACIS Group, Pulmonary and Critical Care Medicine, and Physical Medicine and Rehabilita- tion (DMN), Johns Hopkins University, Baltimore, MD; Nursing Excellence and Advanced Practice (JD), Scripps Mercy Hospital, San Diego, CA; Pharmacother- apy (HC), Kingsbrook Jewish Medical Center, Wood- mere, NY; Medicine, Pulmonary, and Critical Care (ROH), Intermountain Medical Center, and Psychology and Neuroscience Center, Brigham Young University, Salt Lake City, UT; Pulmonary, Allergy, Critical Care, and Sleep Medicine (CW), Clinical Outcomes Research Center, University of Minnesota, Minneapolis, MN; An- esthesiology and Epidemiology (HW), Columbia Univer- sity, New York, NY; Pediatrics (CZ), Mount Sinai Kravis Children’s Hospital, Brooklyn, NY; Department of Prac- tice (ABD), American Physical Therapy Association, Alexandria, VA; Physiotherapy Department (SCB), Aus- tin Heath, Melbourne, Australia; Psychiatry and Behav- ioral Sciences (OJB), Johns Hopkins University, Balti- more, MD; Research (SLB), Marianjoy Rehabilitation Hospital, Roselle, IL; Physical Medicine and Rehabili- tation (MBB), Johns Hopkins University, Baltimore, MD; Physiotherapy (LD), Melbourne School of Health Sci- ences, University of Melbourne, Melbourne, Australia; Faculty of Nursing (DE), University of Technology, Syd- ney, Australia; Sepsis Alliance (CF), Tampa, FL; Divi- sion of Lung Disease (ALH), National Heart, Lung, and Blood Institute, Bethesda, MD; Critical Care Rehabili- tation (CJ), Whiston Hospital, Prescot, United Kingdom; Critical Care (DL), Kaiser Sunnyside Medical Center, Clackamus, OR; Illinois Citizens for Better Care (WM), Chicago, IL; Hospital Division (SRM), Kindred Health- care, Louisville, KY; Physical Medicine and Rehabilita- tion (JBP), Otolaryngology, and Functional Medicine, Johns Hopkins University, Baltimore, MD; Physical Therapy (CP), The Methodist Hospital, Houston, TX; Occupational Therapy (MR), University of Chicago Medical Center, Chicago, IL; Pulmonary and Critical Care (DMS), Kaiser Sunnyside Medical Center, Clacka- mus, OR; Northern California Quality Department (ES), Kaiser Permanente, San Jose, CA; Cancer Rehabilita- tion Program (GS), Rehabilitation Institute of Chicago, Chicago, IL; American Academy of Hospice and Palli- ative Medicine (CPS), Boulder, CO; Inpatient Evaluation Center (MR), Veterans Affairs Medical Center– Cincinnati, and Pulmonary/Critical Care/Sleep, Univer- sity of Cincinnati College of Medicine, Cincinnati, OH; Hospital for Special Care (JV), New Britain, CT; Critical Care Educator and Consultant and Past President So- ciety of Critical Care Medicine (MAH), Lake Tahoe, NV. The authors have not disclosed any potential con- flicts of interest. For information regarding this article, E-mail: Dale.needham@jhmi.edu Copyright © 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins DOI: 10.1097/CCM.0b013e318232da75 Background: Millions of patients are discharged from intensive care units annually. These intensive care unit survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. Objectives: To report on a 2-day Society of Critical Care Med- icine conference aimed at improving the long-term outcomes after critical illness for patients and their families. Participants: Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional orga- nizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. Design: Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the po- tential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. Measurements and Main Results: Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postin- tensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cogni- tive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. Conclusions: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strate- gies were developed to address the major themes arising from the conference to improve outcomes for survivors and families. (Crit Care Med 2012; 40:000 – 000) KEY WORDS: aftercare; caregivers; continuity of patient care; critical care; follow-up studies; intensive care units; outcome assessment; patient care planning; patient care team; postinten- sive care syndrome; posttraumatic; stress disorders; survivors 1 Crit Care Med 2012 Vol. 40, No. 2