Project helps staff, patients and family prepare for life after the ICU

life after icu 

(l-r): Elaine Bonoan, PA-C and Karen Marlett, PA-C


Physicians and staff on the Medical Intensive Care Unit are experts at treating patients with multiple, sometimes life-threatening, conditions. But the challenges these patients face can go beyond their medical conditions and hospital stays and in some cases, beyond the patients themselves.

Elaine Bonoan, PA-C, and Karen Marlett, PA-C, are shedding light on these challenges through a Post-ICU Outreach project on Yale New Haven Hospital’s MICU. Both are physician assistants with Northeast Medical Group who work with YNHH’s Hospitalist Service and Yale Medicine Pulmonary Critical Care group.

They were awarded a $10,000 IMPACT grant from the PA Foundation for their project, which focuses on post-intensive care syndrome (PICS). The syndrome encompasses physical, cognitive and/or psychosocial problems that remain after a critical illness and ICU stay, such as difficulty thinking clearly; anxiety, depression and post-traumatic stress; muscle weakness; and others. Patients’ loved ones can be affected by PICS-F (post-intensive care syndrome – family).

“We know our patients are fighting a battle while they’re here,” Marlett said. “This project is opening our eyes to the fact that they’re fighting an even bigger battle after they leave.”

Through the project, which launched in January, a PA-led liaison team identifies patients with or at high risk for PICS and implements measures to improve their inpatient and post-discharge care and experiences.

Bonoan said many healthcare professionals are familiar with PICS symptoms, but don’t know a lot about the syndrome as a whole, so the Post-ICU Outreach project incorporates education for MICU staff and the public. During National Critical Care Awareness and Recognition Month in May, Bonoan and Marlett hosted an information table at YNHH to raise awareness about the syndrome.

For patients and family members, they created a simple, one-page PICS fact sheet. They used grant funds to purchase journals where patients or loved ones can record information about medications, care-team members and other aspects of care, along with daily goals. The journals also have blank pages for “thoughts.”

Patients and families don’t have to share the journals with care-team members, but MICU staff who do see them find them helpful, Bonoan said.

“A big component of this project is listening to patients’ and family members’ stories so we can better understand their experiences,” she said. “This helps us engage patients and their families in their care.”

Ultimately, Bonoan and Marlett want to implement a consult service to follow patients after their ICU stays and help coordinate their care.

“This project is designed to yield information that will help us deliver better care, in the hospital and after discharge,” Bonoan said. “Our goal is to minimize the chance of patients acquiring PICS.”