Medicine (Austin & Northern Health) - Theses
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ItemLife after life-support( 1998)This research project examined the 639 admissions to the intensive care unit at the Royal Melbourne Hospital between 1 July and 31 December 1993. The data were examined from a biopsychosocial perspective using both qualitative and quantitative methods. I demonstrate that the lack of commitment to provide ongoing health and social services in the community diminished the efforts made in the intensive care unit. Although the commitment to “save lives” in the intensive care unit was evident in the 90% survival rate, the failure to provide adequate follow-up care in the general wards and the community contributed to both the 10.5% readmission rate to the intensive care unit and the 101 unplanned readmissions to hospital. Six months after discharge from the intensive care unit, patients’ perceived health status, functional recovery and “quality of life” were assessed by personal interviews and self-reported questionnaires. Although 90% of the survivors were living at home, this did not always imply a “successful” outcome. While the degree of dependency varied, many patients required ongoing care in the community. The reliance on families to provide this care is located within a broader social and political ideology. In this thesis, I argue that there was a failure to recognise the integral relationship between intensive care units and other parts of the health care system. This resulted in life-saving crisis interventions in the intensive care unit without a continuity of care. To ensure that the life-saving efforts in the intensive care unit are worthwhile, the current biomedical and economic perspective needs to be complemented with a more holistic approach to health care. Recognising that patients have special needs after discharge from the intensive care unit, that the technological “fix” does not occur in isolation, and that the recovery process may be slow and long, is crucial. Continuity of care in both the general hospital wards, the rehabilitation hospital and the community makes the difference between patients thriving and merely surviving.