Critical illness survivorship necessitates comprehensive care delivery paradigms across the continuum of care. In recent years, ICU follow-up clinics have emerged to meet the dynamic needs of ICU survivors and their care partners. The advent of novel technologies including teleconferencing, wearables, and sensors, has facilitated the development of telemedicine-based ICU follow-up clinics, leveraging objective asynchronous assessments, physiological data monitoring, and virtual care to make follow-up care more broadly accessible. Further, telemedicine-based ICU follow-up clinics may allow for more personalized care, allowing providers to provide timely, data driven care regardless of physical location. With regulatory body support of telemedicine and virtual care, telemedicine-based ICU follow up clinics may stand to improve patient outcomes and reduce fragmentation of care using digital health solutions.

Survivors of critical illness frequently experience dyspnea. While often multifactorial, dyspnea may result from various pulmonary and diaphragmatic complications. Early detection and targeted interventions are crucial for managing these complications effectively. Due to the diverse nature of the respiratory conditions that patients encounter following critical illness, establishing universal instruments to evaluate pulmonary function in the post-ICU setting is challenging. Spirometry, plethysmography, diffusing capacity of the lung for carbon monoxide, and the six-minute walk test are commonly used measures; howevber, it is important that these measures be interpreted in the context of patient-centered outcomes, such as health-related quality of life. This chapter proposes a framework for effective pulmonary follow-up in an ICU follow-up clinic, focusing on individualized care through a multidisciplinary approach.

Suicide is a leading cause of death for young people (variously defined as those aged up to 24-29 years) worldwide. Non-fatal self-harm, which we define as including all intentional acts of self-poisoning (e.g., intentional drug overdoses, ingestion of products not intended for human consumption) or self-injury (e.g., self-cutting) regardless of degree of suicidal intent or other types of motivation is more common. In this chapter, we do not distinguish between attempted suicide and non-fatal self-injury as there is a high degree of co-occurrence between the two behaviours, particularly in young people.

The larynx is positioned at the intersection of the airway, swallowing, and voicing. Critically ill patients often require intubation, putting the larynx at inherent risk. Increased knowledge and awareness of the critical roles of the larynx and risks associated with intubation will help clinicians mitigate and address issues that arise related to laryngeal dysfunction or injury. This chapter will detail laryngeal anatomy and function, vocal cord dysfunction, laryngeal and subglottic injury, and tracheotomy, including decannulation. Consideration of interdisciplinary care for these complex patients helps to adequately address and manage these laryngeal disorders. Management of larynx-related dyspnea and dysphonia is discussed.

The framework set out in this book reconceptualises the problem of dementia care as a problem of power and social exclusion. At every stage, the goal should be to empower recipients of care to meet their own needs and participate fully in social life as equals, necessitating restrictions on the power of carers and radical changes to our cultural assumptions about and depictions of dementia. Though few would disagree that Western dementia care services are in need of reform, the book’s emphasis on social equality means that the depth and character of the proposed reforms differ significantly from many of those under public discussion. Indeed, as demonstrated in this chapter, significant changes would be needed to the way the UK treats people living with dementia under the law in order to support the reforms recommended in this book.

Animal assisted interventions offer benefits for patients, loved ones, and staff within the intensive care environment. They support humanization of a clinical space, improves interactions with familes, and enhance the patient and staff experience. The evidence base for animal assisted interventions in intensive care is an innovative area for clinical research. Specific guidance is available for the clinical application of animal assisted interventions. Therapy animals offer a useful adjunct to optimising functional activity and rehabilitation for patients in Intensive Care.

Chapter 5 focuses on the regulation of physician-assisted suicide and euthanasia, or medically assisted dying. The chapter considers whether restricting access to assisted dying to people with impairments amounts to disability discrimination. It contends that any ‘right to die’ should apply no more to people with impairments, including those with life-threatening conditions, than to others. The chapter concludes that impairment-based eligibility for assisted dying legally entrenches ableism and that only disability-neutral assisted dying laws would be compatible with disability rights.

Critically ill patients require focused attention on medications both during and after their hospitalization to minimize the complications of post-intensive care syndrome. Pharmacists are optimally positioned to provide comprehensive medication services to help facilitate transitions of care from the ICU to the post-hospital setting. Pharmacists are essential to ensure that patients are educated about their medications, and that barriers to medication access and adherence can be overcome. The participation of a pharmacist in both the ICU and in an ICU follow-up clinic has consistently been demonstrated to promote safer, more cost-effective care and helps to ensure that appropriate medications are initiated, inappropriate medications are discontinued, drug-drug interactions are avoided, and adverse drug effects are identified and/or avoided altogether.

Millions of Americans survive critical illness each year, only to be faced with new life-altering impairments in physical, cognitive, and mental health function that alter their ability to live independently. The mechanisms underlying these sequelae of critical illness are incompletely understood but are believed to develop as a function of the severity of the critical illness and the patient’s underlying vulnerability. Clinically, a patient’s underlying vulnerability can be understood as the syndrome of frailty.

Frailty affects 30% of those with critical illness and over 40% of survivors of critical illness. The presence of frailty at ICU admission confers a greater risk of death and, among survivors, disability in activities of daily living. Validated tools including the Clinical Frailty Scale, the frailty index, and the frailty phenotype can be used to identify frailty in those affected by critical illness. While effective interventions such as physical activity, nutritional support, and palliative care can reduce age-related frailty among community-dwelling older adults, the efficacy of these interventions in those along the continuum of critical illness is an area of ongoing study.

Pre-approval access rights to potentially life-preserving experimental treatment is the focus of Chapter 7. The chapter considers whether people with life-threatening conditions should have a right to access possibly life-saving experimental treatments, as embodied in right to try laws. It argues that, despite their significant shortcomings, right to try laws bolster disability rights by seeking to advance the right to life and survival of people with life-threatening conditions beyond medically assisted dying.

Despite surviving critical illness, limitations in physical function can be present for months to years following hospital discharge. Physical disability in survivors of critical illness may present as an impairment in a single body function or as multiple deficits by affecting several body structures and domains. Physical therapists should utilize performance-based and self-report outcome measures to assess physical disability in individuals surviving critical illness; assessment should occur early during recovery and be repeated based on individual needs. This chapter reviews the literature highlighting the frequency and severity of physical impairment and disability related to post-intensive care syndrome and describes physical therapy approaches for screening, assessment, and interventions for survivors of critical illness. In this chapter, we use the term physical disability to be inclusive of the physical symptoms, impairments, and limitations in physical function commonly experienced in survivors of critical illness.

Developing and teaching teamwork skills among healthcare professionals is essential in educational curricula and professional development programs, as effective teamwork is known to be vital for delivering safe, efficient, and patient-centered care. Three well-known frameworks have been used in healthcare to improve training in teamwork: High-Reliability Organizations (HRO), TeamSTEPPS, and the Sunnybrook Framework. Although these frameworks for interdisciplinary care are well known in healthcare, social scientists and anthropologists look at healthcare teamwork through a different lens, and research in this area is evolving. There is little research on outpatient intensive care unit (ICU) follow-up clinic teams, but we can potentially extrapolate from the literature of inpatient ICU teams. Work on team function in inpatient ICU teams indicates that the level of collaboration or conflict amongst the team fluctuates. It is reasonable to surmise that outpatient multidisciplinary teams would function similarly to inpatient teams but at a different pace. Being cognizant of perceptions of ownership of distinct components of clinical care and the rules for interacting with others from different professions will allow outpatient teams to deliver effective care. Reflection on the efficacy of the teamwork, considering using patient and family feedback, will allow teams to continue to grow.