Vanderbilt ICU Recovery Program Pilot Trial
Phase: NA
Conditions: Intensive Care Unit Syndrome, Intensive Care Neurological Disorder, Intensive Care (ICU) Myopathy, Intensive Care Psychiatric Disorder (Diagnosis)
Sponsor: Vanderbilt University Medical Center

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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Vanderbilt ICU Recovery Program (VIP): 
A Quality Improvement Pilot 
 
 
 
 
Principal Investigators 
 
Sarah Bloom MSN, AGACNP-BC 
Medical Intensive Care Unit 
Vanderbilt University Medical Center 
& 
Joanna Stollings, PharmD, FCCM, BCCCP, BCPS 
Department of Pharmaceutical Services 
Vanderbilt University Medical Center 
 
 
 
Faculty Mentors 
 
Matthew Semler, M.D., M.Sc. 
Division of Pulmonary and Critical Care Medicine 
Vanderbilt University Medical Center 
& 
Carla Sevin, M.D. 
Division of Pulmonary and Critical Care Medicine 
Vanderbilt University Medical Center 
& 
Daniel Byrne, M.S. 
Department of Biostatistics 
Vanderbilt University Medical Center 
 
 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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Table of Contents: 
 
Study Schema 
1.0 
Study Summary 
2.0 
Background 
3.0 
Rationale, Aims, and Hypotheses 
4.0 
Study Description 
5.0 
Inclusion/Exclusion Criteria 
6.0 
Enrollment/Randomization 
7.0 
Study Procedures 
8.0 
Risks and Benefits 
9.0 
Adverse Events 
10.0 
Study Withdrawal/Discontinuation 
11.0 
Statistical Considerations 
12.0 
Privacy/Confidentiality Issues 
13.0 
Follow-up and Record Retention 
14.0 
References 
 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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1.0 
Summary 
 
Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
 
Background: Every year, millions of Americans are admitted to the intensive care unit.  
Due to advances in critical care, mortality rates are decreasing, increasing the number of 
ICU survivors.  Survivors of critical illness, however, often face physical, functional, and 
cognitive deficits that place them at risk for a cycle of re-hospitalization that frequently 
culminates in premature death.  Moreover, post-ICU interventions may be resource-
intensive and may be most cost-effective only in a subgroup of patients at highest risk.  
Whether a multi-disciplinary program to facilitate recovery from critical illness can 
prevent hospital readmission and improve quality of life among high-risk ICU survivors 
remains unknown. 
 
Primary Aim:  
• To examine the feasibility of implementing a multidisciplinary ICU Recovery 
Program and the influence of such a program on process measures including 
contact with the ICU recovery team and attendance of ICU recovery clinic. 
 
Secondary Aims:  
• To compare the effect of an ICU Recovery Program on 30-day same-hospital 
readmission experienced by ICU survivors at high risk of readmission. 
• To compare the effect of an ICU Recovery Program on the hospital length of stay 
and 30-day mortality experienced by ICU survivors at high risk of readmission. 
 
Primary Hypothesis: 
• Implementation of a multidisciplinary ICU Recovery Program will be feasible and 
will increase contact with the ICU Recovery Team and attendance of the ICU 
Recovery Clinic. 
 
Secondary Hypotheses: 
• A multi-disciplinary ICU Recovery Program will decrease the incidence of 30-day 
same-hospital readmission experienced by ICU survivors. 
• A multi-disciplinary ICU Recovery Program will not affect the hospital length of 
stay or 30-day mortality experienced by ICU survivors at high risk of readmission. 
 
Inclusion Criteria: 
1. Age ≥ 18 years 
2. Admitted to the Medical Intensive Care Unit (MICU) at Vanderbilt University 
Medical Center for at least 48 hours 
3. Estimated risk of 30-day same-hospital readmission greater than 15% 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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4. Not previously enrolled in the study. 
 
Exclusion Criteria: 
1. Long-term residence at a skilled nursing facility 
2. Long-term mechanical ventilation prior to admission 
3. Solid organ or stem cell transplantation 
4. Recorded primary residency > 200 miles from Vanderbilt 
5. Comfort care only 
 
Consent: Because both usual care and the addition of a multi-disciplinary ICU Recovery 
Program are within the current standard of care and there are no known risks or 
benefits to either approach, the study is felt to present minimal risk.  As study group 
assignment would occur immediately at or prior to ICU admission and nearly all ICU 
patients might conceivably be eligible, obtaining individual informed consent is felt to be 
impracticable.  Given the minimal risk and impracticability of consent, we will seek 
waiver of informed consent when examining the feasibility of implementing this ICU 
Recovery Program into practice. 
 
Randomization:  Vanderbilt’s Office of Quality, Patient Safety and Risk Prevention 
displays an estimated risk of 30-day same-hospital readmission for a random half of 
patients admitted to Vanderbilt University Medical Center.  The risk score and group 
assignment generated at hospital admission by the Cornelius Quality Improvement 
Project will be used for the current study.   
 
Study Interventions: 
• Usual Care: Patients will receive post-ICU care as dictated by their clinical team. 
•  ICU Recovery Program: Patients will receive a 10-component ICU Recovery 
Program intervention including: (1) a nurse practitioner in-person visit between 
ICU transfer and hospital discharge, (2) an ICU Recovery Program pamphlet, (3) a 
pharmacist medication reconciliation at the time of ICU transfer, (4) an ICU 
Recovery Program contact line, (5) a nurse practitioner history and physical in 
ICU Recovery Clinic, (6) a pharmacist medication reconciliation in ICU Recovery 
Clinic, (7) a cognitive/mental health assessment and psychoeducation in ICU 
Recovery Clinic, (8) a case management consultation in ICU Recovery Clinic, (9) a 
patient centered consultation with PCCM physician in ICU Recovery clinic, (10), 
directed subspecialty referrals. 
 
Endpoints:   
• Primary: Number of ICU Recovery Program intervention components received. 
• Secondary: 30-day same-hospital readmission, hospital length of stay, mortality 
 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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2.0 
Background 
 
Accelerating ICU Admissions and Decreasing Mortality: The Problem of Survivorship.   
Every year, more than 6 million people in North America are admitted to a 
general medical or general surgical intensive care unit (ICU).  Hospitalizations for the 
most common life-threatening critical illnesses such as sepsis and Acute Respiratory 
Distress Syndrome (ARDS) are significantly increasing(1).  Due to advances in critical 
care, mortality rates have significantly declined for many critical illness diagnoses, 
bolstering the ranks of ICU survivors.  However, the cost of survivorship is high. These 
individuals are alive yet suffer from new and persistent deficits(2).  Their post-critical 
illness challenges are challenges of survivorship, marked by burdens and legacies of 
critical illness, including physical, functional, mental health, and cognitive deficits and a 
cycle of re-hospitalizations, frequently culminating in premature death(3–6). 
 
Mortality and Rehospitalization in Survivors of Critical Illness.   
Survivors of critical illness have a high risk of death and hospital readmission in 
the first month after ICU discharge(7, 8).  In a recent analysis of pilot data in 447 ICU 
survivors at Vanderbilt University Medical Center, 40% of individuals had been 
hospitalized at least once between discharge and 3 months and approximately half had 
been re-hospitalized at least once in the year following hospital discharge.  Similar 
findings have been reported elsewhere, with a recent investigation in the American 
Journal of Medical Science reporting that half of ICU survivors are re-admitted to the 
hospital or the ICU in the 12 months after discharge(9).  Although much attention has 
been given to elderly and previously ill patients cared for in ICUs, one recent study 
found that excess mortality and hospital costs after critical illness were highest in 
younger patients without significant comorbidity(10). Importantly, 40% of readmissions 
within 90 days of a hospitalization for sepsis were found to be potentially avoidable(11). 
 
Tailored Treatment to Improve Outcomes in Survivors Critical Illness – A Conspicuous 
“Gap.”   
Multidisciplinary programs designed for cohorts such as heart failure patients 
and cancer survivors are rapidly proliferating(12), yet programs tailored to care for 
survivors of critical illness are extremely rare.  Interest in the topic of “ICU survivors” has 
grown explosively since 1990, as reflected in a ~ 3,000 % increase in in PubMed indexed 
citations in the last 25 years.  Yet, few institutions have developed and implemented ICU 
Recovery Programs, and whether such programs can be effectively delivered to patients 
remains unknown. 
 
Survivorship Care:  A Survey of Early Attempts to Improve Outcomes in ICU Survivors.   
Interdisciplinary programs designed for survivors of other medical conditions – 
largely cancer – have multiplied since the early 2000s(12).  Over 300 cancer survivorship 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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programs exist.  The services they provide are increasingly viewed as indispensable to 
excellent cancer care (many clinicians would characterize them as “standard of care”; 
evidence from numerous studies has shown that they improve a wide range of patient 
centered outcomes(13).  In contrast, though ICU Recovery Programs are of interest at 
many centers across the United States, there is currently very little experience with their 
development and implementation, and no data to suggest whether they may improve 
patient-centered outcomes.  
 
The small number of studies available about ICU Recovery Programs have been 
done outside the U.S. and have not shown clear benefit.  A British trial investigating the 
effects of a nurse led ICU follow up program (PRaCTICaL) failed to show any difference 
in health related quality of life (HRQL) between control and intervention groups at one 
year(14).  In this study, 143 patients were randomized to a self-directed rehabilitation 
program.  The authors outline several possible explanations for why the intervention did 
not improve HRQL, including the failure to integrate family in recovery, medical 
complexity requiring a multidisciplinary approach to this population (which PRaCTICal 
did not provide), and the timing of the intervention (too distant from hospital 
discharge).   A Swedish post-ICU multidisciplinary follow-up clinic was implemented by 
Schandl et al but suffered from poor participation, a small sample size (N=61), and no 
controls(15).  Patients were seen prior to hospital discharge and invited to come back at 
3, 6, and 12 months after ICU discharge.  Nearly a third died before the first follow-up 
visit, and a third of survivors declined follow up, resulting in very few complete 
interventions.  Patients who declined follow-up had significantly higher comorbidity 
scores, suggesting that the individuals who needed it most did not receive the 
intervention.  Petersson and colleagues offered a follow- up program based on three 
contacts during the 6 months following critical illness; half of these contacts occurred 
exclusively via telephone(16).  Of the 96 patients enrolled, only 51% visited the 
outpatient nurse led clinic, and they were younger and healthier than those who did not 
follow up.  This study’s first outpatient visit was 2 months after discharge.  No 
effectiveness data was reported.   
 
In contrast to these negative findings, Khan and colleagues at the Indiana 
University School of Medicine recently reported on the results of their newly formed 
Critical Care Recovery Center (CCRC) and described positive outcomes from a total of 53 
patients seen at their clinic between July 2011 and May of 2012(17).  Patients were seen 
immediately after hospital discharge by members of a multidisciplinary team that 
included a physician, a nurse, a case manager, and a mental health professional, among 
others, and when deemed appropriate, were followed multiple times after their initial 
appointment.  Among patients who were seen twice (N=24), statistically significant 
improvements were noted on a symptom checklist (Healthy Aging Brain Center Monitor 
– HABC-M tool) with a reduction in symptoms reported in cognitive (p=0.04) and 
functional (p=0.02) domains and with respect to overall symptoms (p=0.01); data were 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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analyzed in a simple univariate fashion.  Of note is the fact that this study was done with 
a population of “high risk” patients who may be the subgroup of ICU patients most 
likely to benefit from a resource intensive post-ICU intervention. 
 
ICU Recovery Clinic at Vanderbilt 
In 2012, we developed a multidisciplinary ICU Recovery Clinic at Vanderbilt.  
Similar to the Indiana experience, our patients are unexpectedly young (mean age 55), 
survived a severe critical illness (mean SOFA score 10), and are markedly impaired.  A 
third cannot walk unassisted at their first visit (an average of 30 days after hospital 
discharge), and more than half are cognitively impaired.  For the last four years, the ICU 
Recovery Clinic has seen patients on an as-needed, by-referral basis, outside of the 
context of any structured ICU Recovery Program.  With improving understanding of 
intense needs of ICU patients starting immediately at the time of ICU transfer and 
persisting through at least the first month of hospitalization, we have developed a 10-
component multidisciplinary ICU Recovery Program which would provide multiple 
assessments and interactions with patients from the time of transfer out of the ICU to 
the hospital ward, between hospital discharge and clinic follow up, and during our ICU 
Recovery Clinic visit.  We are planning to implement this 10-component ICU Recovery 
Program at Vanderbilt.  The planned program, however, is resource-intensive and 
whether such a program is (1) feasible to implement and (2) improves patient-centered 
outcomes like 30-day hospital readmission will be important to know if such a program 
is to be sustained over the long term.  Thus, we propose in the first 6 months of the ICU 
Recovery Program’s implementation, to examine the delivery of each of the 
components of the intervention and the effect on 30-day readmission, in comparison to 
current usual care.  To focus our ICU Recovery Program intervention on those patients 
most likely to benefit, we will target a population of ICU patients specifically felt to be at 
“high risk” of subsequent 30-day hospital readmission.  Targeting “high risk” patients is 
important because these individuals have the greatest needs and the largest room to 
improve.

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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3.0 
Rationale, Aims, and Hypotheses 
An ICU Recovery Program may reduce 30-day same-hospital readmission rates 
and improve clinical outcomes and quality of life among adults recovering from critical 
illness.  Development and implementation of an ICU Recovery Program, however, faces 
significant logistical challenges and the best model for providing care for survivors of 
critical illness remains unknown.  Preliminary data on the feasibility and safety of 
developing and implementing an ICU Recovery Program are needed.   
 
Primary Aim:  
• To examine the feasibility of implementing a multidisciplinary ICU Recovery 
Program and the influence of such a program on process measures including 
contact with the ICU recovery team and attendance of ICU recovery clinic. 
 
Secondary Aims:  
• To compare the effect of a multi-disciplinary ICU Recovery Program versus usual 
care on the incidence of 30-day same-hospital readmission experienced by ICU 
survivors at high risk of readmission. 
• To compare the effect of a multi-disciplinary ICU Recovery Program versus usual 
care on the hospital length of stay and 30-day mortality experienced by ICU 
survivors at high risk of readmission. 
 
Primary Hypothesis: 
• Implementation of a multidisciplinary ICU Recovery Program will be feasible and 
will increase contact with the ICU Recovery Team and attendance of the ICU 
Recovery Clinic. 
 
Secondary Hypotheses: 
• A multi-disciplinary ICU Recovery Program will decrease the incidence of 30-day 
same-hospital readmission experienced by ICU survivors at high risk of 
readmission compared with usual care. 
• A multi-disciplinary ICU Recovery Program will not affect the hospital length of 
stay or 30-day mortality experienced by ICU survivors at high risk of readmission 
compared with usual care. 
 
 
4.0 
Study Description 
 
To address the aims outlined above, we propose a pilot evaluation of an ICU 
Recovery Program for patients in the Vanderbilt MICU at high risk of readmission.  Adult 
patients admitted to the Vanderbilt MICU with a high risk of readmission after hospital 
discharge who do not meet exclusion criteria will be enrolled and assigned to either 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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usual care or participation in an ICU Recovery Program.  All other aspects of patients’ 
care will be at the discretion of their treating providers.  Data will be collected during 
the ICU admission, between ICU transfer and hospital discharge, and at 30 days after 
hospital discharge to determine the effect of the ICU Recovery Program on short- and 
long-term outcomes. 
 
 
5.0 
Inclusion and Exclusion Criteria 
 
5.1  
Inclusion Criteria: 
5. Age ≥ 18 years 
6. Admitted to the Medical Intensive Care Unit (MICU) at Vanderbilt University 
Medical Center for at least 48 hours 
7. Estimated risk of 30-day same-hospital readmission greater than 15% 
8. Not previously enrolled in the study. 
 
5.2  
Exclusion Criteria:  
1. Long-term residence at a skilled nursing facility 
2. Long-term mechanical ventilation prior to admission 
3. Solid organ or stem cell transplantation 
4. Recorded primary residency > 200 miles from Vanderbilt 
5. Comfort care only 
 
Notes: 
(1) Patients’ estimated risk of 30-day same-hospital readmission are calculated currently 
as part of the Vanderbilt Office of Quality, Patient Safety and Risk Prevention Cornelius 
project which displays patients’ estimate risk of 30-day same-hospital readmission with 
the electronic health record. 
(2) Because enrollment occurs during the MICU admission and the ICU Recovery Program 
Intervention is delivered primarily after transfer out of the ICU, there will be patients 
enrolled who die before hospital discharge or are discharged with hospice care, such that 
they do not have an opportunity to receive the full study intervention.  These patients 
will be enrolled and followed, but will not be analyzed in the primary ‘per-protocol’ 
analysis (see Statistical Analysis). 
 
 
6.0 
Enrollment/Randomization 
 
6.1 
Study Sites:  Medical Intensive Care Unit at Vanderbilt University Medical Center 
 
6.2  
Study Population:  All adults admitted to the MICU at VUMC for at least 48 
hours with an estimated risk of 30-day same hospital readmission greater than 15% not 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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meeting exclusion criteria.  Patients will be included regardless of gender, race, or other 
clinical factors.  
 
6.3  
Enrollment:  All patients will be enrolled at the first time-point at which they 
meet all inclusion criteria without meeting exclusion criteria.  Data on patient age, 
hospital location and admitting service, and risk of readmission are currently available 
for each patient in Vanderbilt’s Electronic Health record.  The acute care nurse 
practitioner and pharmacist in charge of the ICU Recovery Program will receive an 
automated report of these data daily and will determine by manual chart review 
whether eligible patients meet any exclusion criteria.  For each eligible patient, the 
medical record number, date and time, and inclusion and exclusion criteria met will be 
recorded in a screening long housed within the secure, online database REDCap.  
 
6.4  
Consent:  
 
 
The approach to post-ICU follow up in current routine care varies greatly by 
location, hospital system, and provider.  Both usual care (in which the treating clinicians 
assist with healthcare transitions, medication reconciliation, and post-discharge follow 
up planning) and an ICU Recovery Program (in which a dedicated multidisciplinary team 
contributes to the same activities) are within the current standard of care.  There are no 
randomized trials or evidence-based guidelines to support the choice of one approach 
to post-ICU follow up over the other.  In many instances, the approach to post-ICU 
follow up a given patient receives depends on arbitrary factors unrelated to that patient 
(availability of an ICU Recovery Program at the hospital, insurance approval of post-ICU 
services, etc).  Importantly, the nature of the ICU Recovery Program intervention 
imposes no additional health or safety risks to the patient above what they would 
experience in either usual care within the study or usual care outside of the study.  We 
therefore feel the ICU Recovery Program presents minimal risk. 
 
Vanderbilt’s Office of Quality, Patient Safety and Risk Prevention has 
implemented the Cornelius program to automatically calculate at the time of hospital 
admission each patient’s risk of 30-day same-hospital readmission.  Currently at 
Vanderbilt, half of the patients have the risk score displayed in the electronic health 
record from the time of hospital admission to discharge, whereas for the other half the 
risk score is not displayed.  Our evaluation of the ICU Recovery Program targeting 
patients at high risk of readmission relies on the Cornelius risk score and group 
assignment (generated at hospital admission).  Obtaining informed consent prior to 
group assignment in the current evaluation of the ICU Recovery Program would require 
identifying and approaching at-risk ICU patients before hospital admission.  Obtaining 
informed consent prior to group assignment would be impracticable. 
 
Moreover, approaching patients for informed consent would introduce biases 
that could potential invalidate the study results.  If patients were approached for 
informed consent before group assignment was generated (not possible due to 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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generation of group assignment for all patients at the time of hospital admission), two 
potential biases would be introduced: 
• A patient or surrogate’s willingness to consent in a study of ICU follow up would 
reasonably be expected to correlate with their likelihood of complying with ICU 
follow up interventions.  Examining the effect of the ICU Recovery Program vs 
usual care only among a subgroup of patients who are more likely to comply 
with the intervention (and excluding a subgroup of patients less likely to comply 
with the intervention) falsely biases the towards demonstrating ‘efficacy’ of the 
intervention, a misleading result given that the goal is to assess the 
‘effectiveness’ of the program as it would be applied across all ICU patients in 
usual care after implementation.   
• Approaching patients for informed consent prior to group assignment would be 
anticipated to alter the care sought and received in the usual care group.  
Patients who are informed of the potential benefits for more intensive ICU 
follow up after critical illness and agree to participate in a study of a 
comprehensive ICU Recovery Program, who are then assigned to receive ‘usual 
care’, could reasonably be anticipated to more actively seek intensive ICU follow 
up (with their primary physician or even as a part of the ICU Recovery Clinic, 
which is available upon request to patients in the usual care group) than they 
would have been in true usual care.  This would falsely limit separation between 
groups and bias toward a negative study because of a more active control group 
that true usual care.  
If patients were approached for informed consent after group assignment, both 
of the above biases would remain present and an additional bias would be introduced:  
Patients might base the decision to participate on their group assignment.  Patients 
might be overall more likely to participate in one group than the other causing selection 
bias, or patients who prefer more intense follow up might refuse participation in the 
usual care group and participate in the intervention group while patients who prefer 
less intense follow up refuse participation in the intervention group but not in the usual 
care group. 
 
Because addition of an ICU Recovery Program to usual care (1) presents minimal 
risk and (2) would not adversely affect the welfare or privacy rights of the participants 
AND because obtaining informed consent would be impracticable both (3) due to the 
inability to approach prior to generation of study group assignment and (4) due to the 
risks of introducing systematic biases into the study findings, we will request a waiver of 
informed consent. 
 
6.5  
Randomization:   
 
Since 2012, Vanderbilt’s Office of Quality, Patient Safety and Risk Prevention 
displayed an estimated risk of 30-day same-hospital readmission for a random half of 
patients admitted to Vanderbilt University Medical Center.  At the time of hospital 
admission, the Cornelius Quality Improvement Project randomizes patients 1:1 to either 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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display a risk of readmission to providers within the electronic health record or to not 
display a risk of readmission. 
 
The risk score and group assignment generated at hospital admission by the 
Cornelius Quality Improvement Project will be used for the current study.  Patients for 
whom a risk score is displayed in the electronic health record will be considered to be in 
the intervention group.  Patients for whom a risk score is not displayed in the electronic 
health record will be considered to be in the control group. 
 
 
7.0 
Study Procedures 
 
7.1       Study Interventions 
 
USUAL CARE (Control) 
 
Patients in the usual care group will receive care as dictated by their clinical 
team.  In usual care in the study institution, patients frequently receive medication 
reconciliation by and ICU pharmacist at the time of transfer out of the ICU to the 
hospital ward, medication reconciliation by a physician at the time of hospital discharge, 
and follow up with their primary care physician within two weeks of hospital discharge.  
Usual care does not currently include an in-person assessment of the patient’s cognitive 
and functional status or anticipated post-ICU needs by a nurse practitioner between ICU 
transfer and hospital discharge, access to a 24/7 contact line after hospital discharge, or 
assessment in a multi-disciplinary ICU Recovery Clinic.  
 
 
 
VANDERBILT ICU RECOVERY PROGRAM (VIP) (Intervention) 
 
In addition to the interventions received as a part of usual care, patients in the 
ICU Recovery Program group will receive a 10-component ICU Recovery Program 
between ICU discharge and 30 days after hospital discharge, as outlined below. 
 
PRIOR TO ICU RECOVERY CLINIC VISIT 
 
Nurse Practitioner In-Person Visit.  At the time of transfer from the ICU to the hospital 
ward, the ICU Recovery Program nurse practitioner will meet in person with the patient 
and family members.  At this visit, the nurse practitioner will obtain a history of the 
patient’s baseline cognitive and functional status, review the events of the patient’s 
critical illness, and assess the patient’s current and anticipated needs during recovery 
(component 1).  Specific interventions at this visit will include: 
• Scheduling request for an appointment in the ICU Recovery Clinic 
• Provision of an ICU Recovery Program Pamphlet describing post-intensive care 
syndrome, details about the ICU Recovery Program services offered, and 
providing online resources (component 2) 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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• Provision of the phone number for the ICU Recovery Program contact line 
 
Pharmacist In-Person Visit.  At the time of transfer from the ICU to the hospital ward, 
the ICU Recovery Program pharmacist will review the patient’s home medications, ICU 
course, and current medication regimen.  Specific interventions at this visit will include: 
• Performance of a formal medication reconciliation (component 3) 
 
ICU Recovery Program Contact Line.  From the time of transfer from the ICU to the 
hospital ward until 30 days after hospital discharge, the ICU Recovery Program Team will 
staff a dedicated 24-hour a day, 7-day a week contact line to serve as a “first call” for 
patients and their families following hospital discharge after critical illness (component 
4). 
 
 
DURING ICU RECOVERY CLINIC VISIT 
 
Medical Examination.  A structured interview will be conducted by a critical care nurse 
practitioner and will cover the patient’s hospital course and any current physical 
problems or complaints.  Data regarding weight change, smoking status, and alcohol 
intake will be collected.  A focused physical with special emphasis on sequelae related to 
critical care (e.g., tracheostomy, respiratory failure, indwelling vascular catheters, 
weakness, skin breakdown) will be conducted.  (component 5) 
 
Medication Reconciliation and Counseling.  A medication reconciliation and counseling 
intervention (component 6) will be conducted by a critical care pharmacist involving:  
• A rapid review of medication discrepancies;  
• A discussion of plans for filling new prescriptions;  
• Anticipation and troubleshooting of barriers to adherence;  
• Provision of adherence aids if appropriate. 
 
Cognitive/Mental Health Assessment and Psychoeducation.  A brief session of 
psychotherapy that includes a cognitive and mental health screening will be conducted 
by a clinical psychologist (component 7).  Following screening, which will occur early in 
the session, there will be:  
• A collaborative discussion using a validated “therapeutic assessment 
model” that highlights potential problems or areas of concerns based on 
the screening and  
• Psychoeducation regarding potential post-discharge cognitive, mental 
health challenges, and family challenges, with focus on placing them in 
the context of “typical” ICU recovery as well as discussing what steps to 
take in the event that external referrals are needed.   
 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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Case Management.  A brief case management consultation will be conducted by a nurse 
case manager (component 8).  It will include linking the patient to relevant resources 
(e.g. community mental health, a fitness to drive assessment, etc), arranging for home 
care services and durable medical equipment as appropriate, and reviewing how to 
access resources such as after-hours clinics and express care.  If the patient does not 
have a PCP, assistance will be provided in obtaining one in their insurance network, or in 
the community, if the patient is uninsured.   
 
Patient Centered Consultation.  A final consultation with patients and their families 
(who in virtually every case attend the clinic along with the patient) will be conducted by 
a PCCM physician to synthesize findings identified by other ICU Recovery Program team 
members, using a validated Patient Centered Consultation (PCC) approach that 
emphasizes communication, partnership, and health promotion (component 9).  During 
this consultation, physiologic testing performed during the visit, including spirometry 
and the six minute walk test will be interpreted, and implications explained.  New and 
persistent diagnoses, treatment plan, additional specialist referrals, and medication 
changes will be reviewed.  Patients and family members will have an opportunity to ask 
questions. A survivorship care plan (SCP)126-130 based on those used in the cancer 
survivorship arena but tailored to address the unique needs of patients after critical 
illness will shared with the patient at this time.  The SCP will include contact information 
for the care team, basic historic health information, detailed information about the 
patient’s critical illness course, a list of medications, and specific recommendations for 
follow-up care with timelines.   
 
AFTER ICU RECOVERY CLINIC VISIT 
 
ICU Recovery Program Contact Line.  From the time of transfer from the ICU to the 
hospital ward until 30 days after hospital discharge, the ICU Recovery Program nurse 
practitioners will staff a dedicated 24-hour a day, 7-day a week contact line to serve as a 
“first call” for patients and their families following hospital discharge after critical illness. 
 
Directed Subspecialty Referrals.  Following the ICU Recovery Clinic visit, additional 
subspecialty referral and ICU Recovery Clinic follow up may be scheduled based on the 
needs assessment developed for the patient during the clinic visit (component 10). 
 
 
8.2 Data Collection 
 
Baseline measures: 
• Name, Medical Record Number, Date of Birth 
• Age, gender, race, ethnicity 
• Hospital admission date, ICU admission date 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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• Number of hospital admissions within the prior 12 months 
• Height, weight, body mass index closest to admission 
• Individual comorbidities, Charlson Comorbidity Index (CCI) Score 
• Employment prior to hospitalization 
• Tobacco use, Alcohol use prior to hospitalization 
 
ICU Measures: 
• Date of first ICU admission during hospitalization 
• Active medial conditions prompting ICU admission; primary ICU diagnosis 
• SOFA score on the first day of ICU admission 
• Receipt of mechanical ventilation, duration of mechanical ventilation; receipt of 
non-invasive mechanical ventilation, duration of non-invasive mechanical 
ventilation 
• Receipt of vasopressors, duration of vasopressor receipt 
• Receipt of renal replacement therapy during the ICU admission, duration of renal 
replacement therapy receipt 
• Delirium during ICU admission, receipt of continuous sedation during the ICU 
admission 
• Date of initial ICU transfer during hospitalization, date of final ICU transfer during 
hospitalization 
 
Post-ICU In-hospital Measures:  
• In-person contact between patient/family and ICU Recovery Team nurse 
practitioner before hospital discharge; date of in-person contact 
• Patient/family provided with ICU Recovery Team Letter and contact information; 
date ICU Recovery Team Letter and contact information provided 
• Was patient scheduled for ICU Recovery Clinic Appointment, Date ICU Recovery 
Clinic Appointment scheduled 
• If patient/family declined appointment, reason appointment was declined 
• Ward service caring for patient after ICU admission 
• Vital status at hospital discharge 
• Date of hospital discharge 
• Hospital discharge location 
• Ambulatory status at hospital discharge 
 
Post-Hospital Measures: 
• 30-day same-hospital re-admission within 30 days of hospital discharge from the 
index admission (primary outcome). 
• Date of re-admission 
• Vital status during follow up; date of last known vital status during follow up 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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• Number of same-hospital emergency department visits in the 30 days after 
hospital discharge 
 
This project will utilize the REDCap platform for data collection and management.  
Project team members listed as Key Study Personnel with existing StarPanel access rights 
may also be granted use of REDCap Dynamic Data Pull (DDP) tools.  These tools are 
designed to enable transfer of relevant study-related data from the Vanderbilt Research 
Derivative into REDCap.  The Research Derivative is a database of clinical and related 
data derived from the Medical Center’s clinical systems and restructured for research. 
Data is repurposed from VU’s enterprise data warehouse, which includes data from 
StarPanel, VPIMS, and ORMIS (Operating Room Management Information System), EPIC, 
Medipac, and HEO among others. The medical record number and other person 
identifiers are preserved within the database. Data types include reimbursement codes, 
clinical notes and documentation, nursing records, medication data, laboratory data, 
encounter and visit data, among others. Output may include structured data points, such 
as ICD 9 codes or encounter dates, semi-structured data such as laboratory tests and 
results, or unstructured data such as physician progress reports. The database is 
maintained by the Office of Research Informatics under the direction of Paul Harris, 
Ph.D. 
 
8.3 Outcome Measures 
 
Primary Endpoint:   
Number of components of the ICU Recovery Program intervention received by 
patients between ICU transfer and 30 days after hospital discharge.  The 10-components 
considered part of the ICU Recovery Program include: (1) nurse practitioner in-person 
visit between ICU transfer and hospital discharge, (2) ICU Recovery Program pamphlet, 
(3) pharmacist medication reconciliation at the time of ICU transfer, (4) ICU Recovery 
Program contact line, (5) nurse practitioner history and physical in ICU Recovery Clinic, 
(6) pharmacist medication reconciliation in ICU Recovery Clinic, (7) cognitive/mental 
health assessment and psychoeducation in ICU Recovery Clinic, (8) case management 
consultation in ICU Recovery Clinic, (9) patient centered consultation with PCCM 
physician in ICU Recovery clinic, (10), directed subspecialty referrals. 
 
Secondary Endpoint:   
30-day same-hospital readmission defined as the proportion readmitted to 
Vanderbilt University Medical Center in the 30 days following hospital discharge. 
 
 Tertiary Endpoints:  
• Days alive and free of same-hospital readmission in the 30 days after hospital 
discharge (re-admission free days) 
• Composite of death or readmission in the 30 days after hospital discharge 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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• Number of same-hospital emergency department visits in the 30 days after 
hospital discharge 
• Number of same-hospital outpatient clinic visits in the 30 days after hospital 
discharge 
• Number of referrals to specialty providers in the 30 days after hospital discharge 
 
 
8.0 
Risks and Benefits: 
For ICU patients at high risk of readmission, there are currently no established 
risks or benefits to the addition of an ICU Recovery Program to usual care.  At this time, 
there is no reason to believe that participation in this study would expose patients to 
greater medical risks or benefits than those experienced by critically ill patients as a part 
of routine care outside of the study.  The greater benefit of the study would be to 
society in the form of improved understanding of the optimal approach to post-ICU 
follow up. 
 
A potential risk to patients participating in this study involves the collection of 
protected health information (PHI).  In order to limit the associated risks, the minimum 
amount of PHI necessary for study conduct will be collected.  After collection, the data 
will be stored in a secure online database (REDCap) only accessible by the investigators.  
After publication, a de-identified database will be generated to protect participant 
privacy. 
 
 
9.0 
Safety Monitoring and Adverse Events: 
 
9.1 Safety Monitoring 
 
Given the nature of the ICU Recovery Program intervention (increased contact 
with a critical care nurse practitioner, pharmacist, and physician) during the 
hospitalization and after discharge, there are no specific safety events anticipated to 
arise from the intervention.  Nonetheless, study personnel blinded to group assignment 
will monitor the records of all participants for 30 days after hospital discharge to 
formally determine the presence of any safety events related to the study.  Study 
personnel will be readily available to answer questions at any time during the study 
course.  If, at any point during the study, a clinical provider feels an alternative approach 
to post-ICU follow up is required for the safe treatment of the patient, the post-ICU 
follow up will be managed in the manner the treating clinician judges to be safest.   
 
9.2 Adverse Events 
An adverse event is defined as any untoward medical occurrence in a clinical 
investigation participant administered an intervention that does not necessarily have to 
have a causal relationship with this treatment.  An adverse event therefore can be any 
unfavorable and unintended sign, symptom, or disease temporally associated with the 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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use of an intervention, whether or not the incident is considered related to the 
intervention. 
 
A serious adverse event (SAE) is defined as any unexpected and untoward 
medical occurrence that meets any of the following criteria: 
a. Results in death 
b. Is life-threatening (defined as an event in which the participant was at risk of 
death at the time of the event and NOT an event that hypothetically might have 
caused death if it would have been more severe) 
c. Requires inpatient hospitalization 
d. Prolongs an existing hospitalization 
e. Results in persistent or significant disability or incapacity 
f. Results in a congenital anomaly or birth defect 
g. Important medical event that requires an intervention to prevent any of a-f 
above. 
 
The Principal Investigators will be responsible for overseeing the safety of this 
study on a daily basis.  They will be available at any time for questions from the bedside 
physicians and nurses, who will also be monitoring the patients continuously for adverse 
events and serious adverse events during the hospitalization.  Serious and unexpected 
adverse events associated with study interventions will be recorded in a case report 
form in the study record and reported to the IRB within 7 business days.  As critical 
illness requiring ICU admission is independently associated with numerous adverse 
events (irrespective of the approach to post-ICU follow up) including death, cardiac 
arrest, hemodynamic or respiratory failure, ICU readmission, hospital readmission, and 
prolonged cognitive or physical impairment, these events are expected in the routine 
care of critically ill adults and will not be individually recorded and reported to the IRB as 
unexpected serious adverse events. 
 
 
10.0 
Study Withdrawal/Discontinuation 
Patients can be withdrawn from study participation in the following circumstances: 
• The investigator decides that the patient should be withdrawn for safety 
considerations. 
• The treating clinician decides the patient should be withdrawn for any 
reason. 
• The patient or surrogate decision makers decides the patient should be 
withdrawn for any reason. 
• There is a significant protocol violation in the judgment of the primary 
investigator. 
The reason for and date of every withdrawal will be recorded in the patient study 
records.  Follow-up will be performed for all patients who discontinue due to an adverse 
event or any other safety parameter.  Follow-up will also be performed for all patients 
who end participation in the protocol for another reason, but who also have an adverse 
event or other safety parameter that could have led to discontinuation.  Follow-up will 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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be conducted until the condition has resolved, until diagnosis of the adverse event or 
safety parameter is deemed chronic and stable, or as long as clinically appropriate.  This 
follow-up will be documented in the patient study record as well.   
 
 
11.0 
Statistical Considerations 
 
Original Sample Size Determination (3/22/17): 
In the six months prior to the design of the pilot, there were 1,602 admissions to 
the Vanderbilt Medical ICU, 340 (21.2%) of whom experienced the primary outcome of 
30-day same-hospital readmission.  Of the 1,602 admissions, 672 (41.9%) had a 
predicted risk of readmission at least 25% at the time of ICU admission, 189 (28.1%) of 
whom experienced the primary outcome of 30-day same-hospital readmission. 
This pilot ICU program will have adequate support for the nurse practitioner and 
bioinformatics staff to run for 6 months.  Based on this fixed duration, we anticipate the 
number of patients enrolled in this pilot study to be around 650.  We anticipate that 
around 15% of patients will be ineligible for participation in the ICU Recovery Program 
due to death in the ICU or transition to hospice, leaving around 550 patients who will 
receive either usual care or the ICU Recovery Program.  Assuming a rate of the primary 
outcome in the usual care group of 28%, 550 total patients will allow us 80% statistical 
power at an alpha level of 0.05 to detect an absolute reduction in the primary outcome 
of around 10%, comparable to a relative risk reduction of 35%. 
 
Revised Sample Size Determination (6/12/17): 
In the six months prior to the design of the pilot, there were 1,602 admissions to 
the Vanderbilt Medical ICU, 340 (21.2%) of whom experienced the primary outcome of 
30-day same-hospital readmission.  Of the 1,602 admissions, 1,236 (77.2%) had a 
predicted risk of readmission greater than 15% at the time of ICU admission, 272 
(22.0%) of whom experienced the primary outcome of 30-day same-hospital 
readmission. 
This pilot ICU program will have adequate support for the nurse practitioner and 
bioinformatics staff to run for 6 months.  The enrollment target for the study is a total of 
650 patients, which (anticipating that around 15% of patients will be ineligible for 
participation in the ICU Recovery Program due to death or transition to hospice) will 
allow a total of 550 patients to receive either usual care or the ICU recovery program.  
After the first month of the trial, in order to achieve the planned enrollment target, the 
study team recognized that the actual rate of enrollment using the initially specified risk 
score of 25% would be inadequate to meet the planned enrollment of 550 patients.  The 
risk score required for inclusion was therefore decreased to >15%.   
Assuming a rate of the primary outcome in the usual care group of 22%, 550 
total patients will allow 80% statistical power at an alpha level of 0.05 to detect an 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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absolute reduction in incidence of the 30-day readmission of 10%, comparable to a 
relative risk reduction of 45%. 
  
 
Statistical Analysis: 
 
Pilot study profile:  
We will present a Consolidated Standards of Reporting Trials diagram as Figure 1 
to detail the movement of patients through the study. This diagram will include total 
number of patients meeting inclusion criteria, number excluded and reason for 
exclusion, number enrolled and randomized in the study, number followed, and number 
analyzed. 
 
Baseline Characteristics:  
To assess randomization success, we will summarize in Table 1 the distribution of 
baseline variables across the study arms. Categorical variables will be reported as 
frequencies and percentages and continuous variables as either means with SDs or 
medians with interquartile ranges. Variables reported will include Demographics (age, 
gender, race, BMI); Comorbidities; Pre-admission location; ICU admitting diagnosis; 
receipt of vasopressors and mechanical ventilation; and severity of illness. 
 
Primary Analysis:  The primary analysis will be an unadjusted comparison of the 
proportion of patients who receive an any ICU Recovery Program intervention in the 
usual care and ICU Recovery Program groups, among patients discharged from the 
hospital alive to a non-hospice location (‘modified intention-to-treat’) using a chi-square 
test.  Enrolled patients who die in the ICU, die between ICU transfer and hospital 
discharge, or who are discharged from the hospital to hospice will not be included in the 
primary analysis.   
 
Secondary Analyses: 
 
Intention-to-treat analysis 
We will perform an unadjusted comparison of the proportion of patients who 
receive an any ICU Recovery Program intervention in the usual care and ICU Recovery 
Program groups, among all enrolled patients (‘intention-to-treat’) using a chi-square 
test.  Enrolled patients who die in the ICU, die between ICU transfer and hospital 
discharge, or who are discharged from the hospital to hospice will be included in this 
secondary analysis.   
 
Modified Intention-to-treat analysis of secondary and tertiary outcomes 
We will conduct an unadjusted analysis examining the effect of the ICU Recovery 
Intervention versus usual care on the pre-specified secondary and tertiary outcomes 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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including 30-day same hospital readmission, among those patients discharged from the 
hospital alive to a non-hospice location. 
 
Per-Protocol Analysis of Primary Outcome in the modified intention-to-treat population. 
We will test the hypothesis that receipt of the full ICU Recovery Program 
intervention is associated with lower 30-day same hospital readmission by comparing 
the incidence of 30-day same-hospital readmission between patients who received all 
component of the ICU Recovery Program intervention and those who did not receive all 
components of the ICU Recovery Program intervention, among those patients 
discharged from the hospital alive to a non-hospice location. 
 
Subgroup Analyses. 
We will conduct unadjusted analyses examining the effect of the ICU Recovery 
Program versus usual care on 30-day same-hospital readmission in each of the pre-
specified subgroups using a formal assessment of statistical interaction.  Data will be 
presented as odds ratios and 95% confidence intervals for categorical variables and as 
mean differences and 95% confidence intervals for continuous variables. 
 
Modeling to Examine Potential Confounding Factors. 
We will develop a multiple regression model with 30-day same-hospital 
readmission as the dependent variable and study group and relevant confounders 
included as independent variables. 
 
Presentation of Statistics 
Continuous variables will be described as mean and standard deviation or 
median and 25th percentile – 75th percentile or bootstrapped 95% confidence intervals 
as appropriate.  Categorical variables will be given as percentage and number.  All 
between-group comparisons with continuous variables will be performed using Mann-
Whitney U tests and chi-square or Fisher’s exact test for categorical variables.  Kaplan-
Meier curves and log-rank tests will be used to analyze time-to-event comparisons 
between groups.   
             
12.0 
Privacy/Confidentiality Issues 
At no time during the course of this study, its analysis, or its publication will 
patient identities be revealed in any manner.  The minimum necessary data containing 
patient or provider identities will be collected.  All patients will be assigned a unique 
study ID number for tracking.  Data collected from the medical record will be entered 
into the secure online database Redcap.  All data will be maintained in the secure online 
database Redcap until the time of study publication.  At the time of publication, a de-
identified version of the database will be generated. 
 
13.0 
Follow-up and Record Retention 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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Patients will be followed for 30 days after hospital discharge.  Data collected 
from the medical record will be entered into the secure online database Redcap.  Once 
data is verified and the database is locked, all hard copies of data collection forms will 
be destroyed.  All data will be maintained in the secure online database Redcap until the 
time of study publication.  At the time of publication, a de-identified version of the 
database will be generated.

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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14.0 
References 
 
 
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Surviv Res Pract 2011; 5:271–282 

Principal Investigators: Sarah Bloom, Joanna Stollings 
 Version Date: 6/12/2017 
Study Title: Vanderbilt ICU Recovery Program (VIP): A Quality Improvement Pilot 
Institution/Hospital: Vanderbilt University Medical Center 
 
 
 
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13.  Kesson EM, Allardice GM, George WD, et al.: Effects of multidisciplinary team 
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collaborative care model for ICU survivors. Am J Nurs 2015; 115:24-31, 46