Kimberely J. Haines PhD, BHSc (Physiotherapy), Western Health
Joanne McPeake PhD, MSc, BN (Hons), RGN, NHS Greater Glasgow and Clyde
Elizabeth Hibbert B.Physiotherapy, Western Health
Leanne M. Boehm PhD, RN, ACNS-BC, Vanderbilt University
Krishna Aparanji MD, CPE, Springfield Clinic
Rita N. Bakhru MD, MS, Wake Forest University School of Medicine
Anthony J. Bastin MBBS PhD, Barts Health NHS Trust
Sarah J. Beesley MD, MSc, Intermountain Medical Center
Lynne Beveridge RGN, NHS Greater Glasgow and Clyde
Brad W. Butcher MD, University of Pittsburgh Medical Center
Kelly Drumright MSN, RN, CNL, Tennessee Valley Healthcare System VA Medical Center
Tammy L. Eaton MSN, RN, FNP-BC, ACHPN, UPMC Mercy
Thomas Farley MS, ACNP, University of California San Francisco
Penelope Firshman BSc, Guy’s and St Thomas’ NHS Foundation Trust London
Andrew Fritschle PharmD, Eskenazi Health
Clare Holdsworth BPhys (Hons), Western Health
Aluko A. Hope MD, MSCE, Albert Einstein College of Medicine of Yeshiva University
Annie Johnson APRN, ACNP-BC, CCRN Mayo Clinic
Michael T. Kenes PharmD, BCPS, BCCCP, Wake Forest Baptist Medical Center
Babar A. Khan MD, MS, Regenstrief Institute Inc.
Janet A. Kloos RN, PhD, APRN-CCNS, CCRN, University Hospitals Cleveland Medical Center
Erin K. Kross MD, University of Washington
Pamela Mactavish BSc Pharm (Hons) MSc.,, NHS Greater Glasgow and Clyde
Joel Meyer BM BCh DM, Guy’s & St Thomas’ NHS Foundation Trust
Ashley Montgomery-Yates MD, University of Kentucky
Tara Quasim MBChB, MD, NHS Greater Glasgow and Clyde
Howard L. Saft MD, MS, National Jewish Health
Andrew Slack MBBS, MRCP, EDIC, MD (Res), Guy’s & St Thomas’ NHS Foundation Trust
Joanna Stollings PharmD, FCCM, FCCP, Vanderbilt University Medical Center
Gerald Weinhouse MD, Brigham and Women’s Hospital
Jessica Whitten PharmD, Eskenazi Health
Giora Netzer MD, MSCE, University of Maryland School of Medicine
Ramona O. Hopkins PhD, Brigham Young University - ProvoFollow
Mark E. Mikkelsen MD, MSCE, Hospital of the University of Pennsylvania
Theodore J. Iwashyna MD, PhD, University of Michigan
Carla M. Sevin MD, Vanderbilt University Medical Center


critical illness, post-intensive care syndrome, peer support, intensive care unit, follow-up clinics


Objective: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of post-intensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.

Design: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.

Setting: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 23 sites, across three continents.

Subjects: Clinicians from 23 sites. Measurement and Main Results: Ten enablers and nine barriers to implementation of ICU follow-up clinics were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of peer support groups were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.

Conclusions: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.

Original Publication Citation

Crit Care Med. 2019 September ; 47(9): 1194–1200. doi:10.1097/CCM.0000000000003818

Document Type

Peer-Reviewed Article

Publication Date



Critical Care Medicine




Family, Home, and Social Sciences



University Standing at Time of Publication

Full Professor

Included in

Psychology Commons