(1250) Behavioral Health in ICU Survivors: An Opportunity to Improve Post-Discharge Transitions of Care

Introduction: ICU Survivors have significant behavioral health (BH) care needs post ICU discharge. We analyzed a cohort of Geisinger ICU survivors for pre-existing, ICU acquired, and post discharge new BH diagnoses, the rate of Usual Care (UC) provider BH screening in post discharge primary care process, and rate of referral to BH care for patients that screened + for BH care needs following ICU discharge.

Methods: We conducted a retrospective chart review of 335 patients admitted to Geisinger Medical Center ICUs from 11/1/16 to 10/31/19 and eligible to participate in ICU Survivor Clinic (ICUSC). We developed and used a data dictionary of BH diagnoses to analyze post discharge progress notes from ICUSC and UC visits to primary care providers to identify rates of prior and newly acquired BH diagnoses, impact of pre-existing BH diagnosis on uptake of ICUSC participation, rates of UC screening for ICU survivor BH needs, and rates of referral to BH providers. Chi-square Test of Independence was used to compare groups.

Results: 33% of cohort had pre-existing BH diagnoses, 17% had new BH diagnosis during ICU stay, 25% had new BH diagnosis post discharge. Pre-admission BH diagnoses were more common in ICU survivors eligible but declined to participate in ICUSC (Chi-square=30.617, p< 0.001) Post discharge new BH diagnoses were more common in the ICUSC full participation sub-cohort (Chi-square=15.270, p< 0.001; 39.58% post discharge new BH diagnosis in ICUSC full participants, 21% in ICUSC partial participants, and 18% in UC cohort.) 29% of UC patients had evidence of BH screening,; 7% of screen + cohort was referred to BH care. Referrals are more likely in patients if in ICUSC sub-cohort or with pre-existing BH diagnoses if in UC sub-cohort.

Conclusions: BH needs are present in majority of ICU survivors and may negatively impact uptake of participation in ICUSC. There is opportunity to improve rate and accuracy of BH screening of ICU survivors for BH diagnoses in the UC cohort, as well as to increase referral to BH providers. This is very important, given increased risk of unplanned utilization of post ICU discharge health care resources when newly acquired BH diagnoses are present in ICU survivors. More research is needed to identify who will improve with more recovery time vs. need for active BH care.