Grace RECOVER Program for Chronic Critical Illness

The Grace RECOVER Program for Chronic Critical Illness seeks to provide a holistic care environment for complex critically ill patients who have required prolonged mechanical ventilation in acute care hospital Intensive Care Units (ICUs) within Toronto.  We are focused on rehabilitation and liberation from mechanical ventilation for those patients who are able to achieve this goal and on transition to community-based home ventilation for those eligible patients who are unable to wean from mechanical ventilation in the Grace RECOVER Program.  For all patients and their caregivers, we strive to optimize physical and cognitive function, mental health and quality of life. 

Our program is patient- and family-centred and unique in the province and country, and led by Critical Care Physicians from the University of Toronto and the Toronto community with support from an expert interprofessional team.

The Grace RECOVER Program for Chronic Critical Illness Program Information for Patients, Caregivers and Families

The Grace RECOVER Program Application Intake Form

Admission Criteria for The Grace RECOVER Program for Chronic Critical Illness:

Patients requiring mechanical ventilation for >14 days, and medically stable for 7 days prior to transfer who have weaning and rehab potential/candidacy for vent to home/vent to palliation in the opinion of the referring critical care physician.

1. Documented Advance Care Plan/Goals of Care discussion within 48h of transfer.
2. Stable ventilator settings for 7 days prior to transfer/Fi-02 < 0.5 on/off the ventilator.
3. Tracheal Suctioning frequency not to exceed q2-3 hours.
4. Tracheostomy in situ/PICC in situ.
5. G/J/PEG tube in situ.
6. No pressor/inotrope use 7 days prior to transfer.
7. No significant medication changes 7 days prior to transfer.
8. No major cardiac or respiratory events 7 days prior to transfer.
9. Hemodialysis is possible – Patient must be pre-scheduled at referring site prior to transfer.
10. If prior COVID infection, documented COVID negative in past 7 days.  Repeat COVID testing will be required 72h prior to transfer.
11. All IPAC practices documented.

Preparation for ICU Discharge

The Grace RECOVER Chronic Critical Illness Clinical Team:

• 24 h/on-site Critical Care / Respirology across academic ( U of T) and community ICU sites.
• 24 h on-site Critical Care/Registered Respiratory Therapy.
• 24 h Critical Care Nurse Manager on site-with RN & RPN team.
• Vent to home/Vent to Palliation.
• Rehab-PTA/OTA–PT/OT.
• Pharmacy.
• Registered Dietitian.
• Music Therapist.
• Therapeutic Recreation.
• Social Workers/Nondenominational Spiritual care.
• PSW support as appropriate.
• Mental Health Support.
• Integration into the community with TGHC as the Hub-Integrated care model upon discharge to the community.
• Integration of Caregiver Support with transition into the community.