RESEARCH Nursing in Critical Care 2003 • Vol 8 No 4 149 Following the path of ICU survivors: a quality-improvement activity Wendy Chaboyer and Joy Grace SUMMARY • Recent interest in continuity of care has meant that the illness trajectory experienced by intensive care unit (ICU) patients has received more attention • Using continuous quality improvement as a framework, this paper describes information obtained during a 3-year period relating to ICU patients’ long-term experiences after being discharged from hospital • This information identified that most participants had been discharged home but that many experienced problems with mobility, disability and fatigue. Changes in employment status and the need for financial assistance were noted • As a result of the information provided by this activity, clinical practice has changed and a number of formal research studies have been undertaken Key words: Clinical outcomes • Continuity of care • Continuous quality improvement • Discharge planning • ICU Over the past decade, the scope of nursing practice, including within intensive care units (ICUs), has devel- oped in line with a number of changes, both techno- logical and societal in nature. Historically, intensive care nurses have wondered what happens to patients once they leave the unit but have lacked the involve- ment in patient care after ICU stay required to gain an understanding of patient progress. However, recent interest in continuity of care has meant a much closer and rigorous examination of the illness trajectory for these critically ill patients (Department of Health, 2000, 2001), and nursing staff have now begun to recognize that a stay in the ICU has long-term implications for patients and their family. A better understanding of patients’ experiences once they leave the ICU and the hospital will allow all nurses to enhance their discharge planning and potentially aid patients in their recov- ery. Using continuous quality improvement (CQI) as a framework, this paper describes information obtained during a 3-year time-span relating to ICU patients’ long-term experiences after hospital discharge with the purpose of better understanding their recovery. As a result of the information provided by this activity, clinical practice has changed and a number of formal research studies have been undertaken. USING CONTINUOUS QUALITY IMPROVEMENT AS A FRAMEWORK In a healthcare environment that increasingly strives for more effective clinical processes and enhanced client outcomes, CQI is a technique that has emerged as a standard and necessary aspect of patient care. Unlike formal research studies that often require specialized research skills and defined external funding, CQI is based on the principles of reflective clinical practice and involvement of clinical staff in the development of more effective pathways, processes and practices. The primary goal of CQI is clinical improvement, where the results of the study immediately feedback to improve the process of care which is being assessed (Bellin and Dubler, 2001). Although there is acknow- ledgement of the overlap between CQI and research (Casarett et al., 2000; Bellin and Dubler, 2001; Byers, 2002), quality-improvement activities do not seek to be generalizable but rather to inform further investi- gation using a process that has similarities to research. In this sense, research issues such as sampling, reliability Authors: W Chaboyer, RN, PhD, Associate Professor, Faculty of Nursing and Health, Griffith University, Bundall, Queensland, Australia; J Grace, RN, Registered Nurse Intensive Care Unit, Gold Coast Hospital, Southport, Queensland, Australia Address for correspondence: W Chaboyer, Centre for Clinical Practice Innovation, Griffith University, PMB 50 Gold Coast Mail Centre, Bundall, Queensland, Australia, 9726 The Gold Coast Hospital, Queensland, Australia has 525 beds that service a fluctuating population of 420,000. It is the major trauma centre for the Gold Coast and northern New South Wales region. E-mail: W.Chaboyer@griffith.edu.au