• Kimberley J Haines, Carla M Sevin, Elizabeth Hibbert, Leanne M Boehm, Krishna Aparanji, Rita N Bakhru, Anthony J Bastin, Sarah J Beesley, Brad W Butcher, Kelly Drumright, Tammy L Eaton, Thomas Farley, Penelope Firshman, Andrew Fritschle, Clare Holdsworth, Aluko A Hope, Annie Johnson, Michael T Kenes, Babar A Khan, Janet A Kloos, Erin K Kross, Belinda J MacLeod-Smith, Pamela Mactavish, Joel Meyer, Ashley Montgomery-Yates, Tara Quasim, Howard L Saft, Andrew Slack, Joanna Stollings, Gerald Weinhouse, Jessica Whitten, Giora Netzer, Ramona O Hopkins, Mark E Mikkelsen, Theodore J Iwashyna, and Joanne McPeake.
• Department of Physiotherapy, Western Health, Sunshine Hospital, Melbourne, Australia. Kimberley.haines@wh.org.au.
• Intensive Care Med. 2019 Jul 1; 45 (7): 939-947.

ObjectiveTo identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs.MethodsQualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine's THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data.ResultsFive key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs-new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU-former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them-clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician's own understanding of patient experience-there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work-this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes.ConclusionsThe follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area.

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