FEATURE CRITICAL CARE
Options Costs Risks Outcomes
Option one:
Make no change
• no imminent cost to trust;
• long-term costs associated with
increased length of stay to trust,
social services, patient and their
family/informal carers.
• not in line with NICE or ICS
guidance;
• risks to patients through
increased length of stay;
• higher risk of hospital acquired
infection;
• increased risk of frailty, nursing
needs and carer burden; and
• more equipment and therapy
needed at discharge.
• potential adverse effects on
patients and carers;
• increased ICU-acquired weakness
due to increased length of stay on
ICU;
• higher health and social care costs
due to increased dependence.
Option two:
ICU to be covered
by existing
occupational
therapy team
• no imminent cost to trust;
• no additional formal occupational
therapy training requirements;
• potential long-term costs
associated with increased
length of stay.
• may not meet NICE/ICS
recommendations;
• staffing is pulled from elsewhere
in the hospital and length of
stay may be increased there if
discharges are delayed;
• no protected time on ICU, so
patients may not be seen; and
• no clear occupational therapy
role specifications.
• may reduce length of stay on
ICU and have a knock-on effect
elsewhere;
• de-prioritisation of ICU caseload
against discharge planning
priorities elsewhere in hospital.
Option three:
Hire one band
six occupational
therapist per five
ICU beds
• Cost to trust: Band six
occupational therapist £40,000
pa; ICU bed day £2,000 a night;
• therefore, occupational therapy
cost would be recuperated
through saving just 20 bed days;
• no formal specialist training
required.
• possible lack of funding to
maintain post;
• potential for absence of support
within occupational therapy team;
• resistance from wider
multidisciplinary team due to lack
of understanding of occupational
therapy role in ICU;
• no clear occupational therapy
role specification.
• cost savings extending beyond
ICU through health and social care;
• patients are more independent
and functional, so they need
less care and less time in
hospital overall.
Risks and outcomes of building a new service
care unit, American Journal of Occupational Therapy,
67(3): 355
Intensive Care Society (2019) Guidelines for the provision of
intensive care services. London: Faculty of Intensive
Care Medicine
National Institute for Health and Care Excellence (2017)
Rehabilitation after critical illness in adults. Quality
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org.uk/guidance/qs158/resources/rehabilitation-aftercritical-illness-in-adults-pdf-75545546693317
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(2009) Early physical and occupational
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Cecily Borgstein was the clinical lead
occupational therapist at NHS Nightingale
London. Her background is in complex
rehabilitation and critical care and she is currently
undertaking an MSc in Global Health (Leadership)
at the University of Plymouth. If you are interested in
knowing more about occupational therapy in critical
care you can join the RCOT Specialist Section –
Trauma and Musculoskeletal Care at: www.rcot.
co.uk/about-us/specialist-sections/trauma-andmusculoskeletal-rcot-ss.
46 OTnews July 2020