Long Stay Critical Care Program helps critically ill patients transition from ICU at MGH

When Beverley’s husband ended up in the Intensive Care Unit (ICU) earlier this year due to complications related to Guillain-Barré syndrome, she knew he could recover. 

“I had confidence he could come back from this,” she says. “The reason he couldn’t breathe – and needed support from a ventilator in the ICU – is because of muscle weakness that was affecting his lungs. I knew this condition was reversible. He just needed the right team – and the right people – to help wean him off the ventilator.” 

Beverley found that team at Michael Garron Hospital (MGH) after her husband's care team noted he was eligible for the Long Stay Critical Care Program (LSP), which aims to support critically ill patients by providing comprehensive rehabilitation services in an ICU setting. 

Patients who are eligible for the program require ongoing critical care supports but are sufficiently stable and expected to have a longer stay in a hospital’s ICU before being discharged to the next most appropriate level of care. 

By providing multidisciplinary and comprehensive rehabilitation during this early stage of recovery from critical illness, the LSP aims to improve short and long-term outcomes for these patients. 

“It was like the sun broke through the clouds,” Beverley says of her husband receiving a referral to the LSP at MGH. “When you’re on a ventilator, you're susceptible to so many infections. What my husband needed – and what he eventually got – were people knowledgeable about and dedicated to progressive weaning.” 

Collaboration key to LSP 

The LSP is a three-year pilot initiative designed to improve overall ICU capacity in Toronto and the quality of care for prolonged critically ill patients. The initiative is funded by the Ministry of Health and supported by Critical Care Services Ontario and Ontario Health. 

As part of the LSP, MGH opened a six-bed unit for long-stay critical care patients in fall 2022. Since then, the program has successfully supported 43 patients who have been referred from partnering hospitals in MGH’s catchment area. 

The program provides concentrated interdisciplinary rehabilitation within a critical care setting, with an emphasis on helping patients and their loved ones navigate through what can be a prolonged period of recovery. 

The LSP at MGH is comprised of an interdisciplinary recovery team, which includes ICU physicians, registered nurses, respiratory therapists, pharmacists, registered dietitians, speech language pathologists, physiotherapists, occupational therapists, social workers and a clinical utilization coordinator. 

The team participates in daily and weekly rounds where they collaborate with patients and their family members to create individualized care plans and work toward mutually established goals. 

“Collaboration among our team is extremely important because we’re essentially taking a rehabilitative approach to caring for patients who have had a life-threatening injury or illness but are now stable enough to potentially be discharged from the ICU,” explains Calvin Mach, Registered Dietitian in MGH’s LSP. 

“It’s an innovative approach to care, so it’s vital for our recovery team to be consistently communicating. This ensures the care plans we put in place for each patient are balanced and complement one another, which ensures the best possible health outcomes.” 

'Always willing to listen’ 

Beverley witnessed this collaboration firsthand during her husband’s time in the LSP at MGH from April to May 2023. She describes the team’s care approach as “very thoughtful” and credits their commitment for helping her husband make great strides in his recovery. 

“My husband is 80 years old, but he is someone who desperately wants to make the most of every moment and enjoy life,” Beverley says. “It was wonderful to see the team so invested in his health and progress.” 

Beverley also says she felt informed and supported every step of the way during her time in the LSP. “The communication was absolutely spectacular,” she says. “I can’t tell you how much it means as a family member to receive that support. The team was always willing to listen.” 

Janet Bowring, Physiotherapist in MGH's LSP, says families are typically very eager to participate in the program. By providing emotional support and assisting with exercises, such as those related to deep breathing and walking, loved ones and the recovery team “work together toward the goal of transitioning the patient out of the ICU,” Janet says. 

“This is a unique program in that it provides specialized care for a specific group of patients that, previously, have not had their own hospital environment where they can recover,” she adds. “It’s really rewarding to see patients make progress and graduate from the LSP.” 

One year of success stories 

Beverley's husband became well enough to be discharged from the ICU in May 2023. At this time, he transitioned from MGH’s ICU to the Provincial Prolonged-Ventilation Weaning Centre of Excellence (PWC), where he continued his progressive weaning and multidisciplinary care of his persistent critical illness. 

When he was able to once again breathe on his own, he transitioned to the Toronto Rehabilitation Institute. He has since returned home where he continues to make progress in his recovery. “I’m just thrilled he’s home,” Beverley says. 

The LSP recently celebrated the first anniversary of its launch at MGH. To enhance their work of supporting patients, the team also recently acquired an indirect calorimeter, a device that measures the gas breathed in and out by a patient to determine their unique energy requirements. This helps ensure patients are consuming the appropriate number of calories during their recovery. 

Beverley’s story is one of many success stories from the LSP. “Thank you from the bottom of my heart for all you did including supporting us during this difficult time,” she says.