Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is funded by The Health Foundation as part of their ‘Scaling Up Improvement’ Initiative.

Background: Many patients have poor quality of life following an intensive care admission. Reduced mobility, dependence on family members and continuing health issues can lead to depression, anxiety and low self-esteem. This can impede the recovery process, increase health care costs, and cause significant burden to individuals, their caregivers and society. Glasgow Royal Infirmary has successfully prototyped a rehabilitation intervention for intensive care unit survivors: InS:PIRE (Intensive Care Syndrome: Promoting Independence and Return to Employment). This unique five-week recovery programme for patients and carers focuses on patient education, peer support and facilitating self-management. It aimed and increase how in control they feel about their health and wellbeing. InS:PIRE was co-produced with service users and is the first intensive care rehabilitation model to include caregivers and encompass health and social support, which is key for optimal recovery. Weekly group physiotherapy and individualised sessions with health professionals aimed to help patients improve their health and participation in society, including return to work. Individualised goals help to measure improvements and help patients to make meaningful changes, which help to improve their health and increase how in control they feel about their health and wellbeing.

Aim: Led by NHS Greater Glasgow and Clyde Health Board, in partnership with University of Glasgow Higher Educational Institute, NHS Healthcare Improvement Scotland, Scottish Government Health and Social Care Quality Unit, and Scottish Intensive Care Society, the team is now implementing the InS:PIRE rehabilitation programme in five centres across four health boards in Scotland. By scaling up InS:PIRE, this project aims to demonstrate that improvement can be successfully implemented across the NHS. Continued collaboration with patients and their caregivers, maintaining a learning approach, and demonstrating long-term benefits will be critical to the successful delivery of the project. These and other challenges, such as integrating health and social care, and ensuring that changes are tested in a local context, will be supported by the broad experience of the wide range of partner organisations involved in the project.

Evaluation: Led from the Health Services Research Unit, University of Aberdeen, the InS:PIRE project will comprise a systematic evaluation. The intensive care setting is challenging and this improvement project involves many disparate stakeholders, including multidisciplinary intensive care staff, as well patients and carers, and several institutions (the Scottish Government's Health and Social Care Unit [HSCU], Healthcare Improvement Scotland [HIS], Patient and Family Councils [PFC], and the Scottish Intensive Care Society [SICS]), as well as the five sites in four Health Boards and the media (TV, press and social media). Rigorous and evolving evaluation is essential to ensure the improvement project is implemented successfully (avoiding predictable mistakes and reducing latencies) and to show the final findings are robust and credible.  The main evaluation purposes are therefore to: (a) conduct an initial Evaluability Assessment; (b) continue to evaluate all aspects of the improvement implementation using a formative approach; and (c) deliver a final independent evaluation (summative approach), with appropriate focus on what didn’t go according to plan and what the remaining challenges are for a nationwide adoption. The evaluation will ensure that all the stakeholders are properly consulted and informed.