Royal Perth Hospital is the largest hospital in Western Australia and also has the largest intensive care unit (ICU) in the State. It was the first public hospital to provide intensive care services in Western Australia. This thesis examines the intermediateand long-term outcomes of patients admitted to the Royal Perth Hospital ICU between 1987 and 2002. Intermediate-term survival, defined as survival after discharge from hospital to one year and long-term survival, that exceeding one year after discharge, are important outcomes. Information on outcomes can be used by ICU staff in discussions with patients and their families and to inform policy decision-making and future research. The aim of this research was to examine one-year and long-term outcomes of patients admitted to the ICU between 1987 and 2002 and explore the factors that might be associated with the outcomes for 22,298 patients admitted to the ICU. A clinical ICU database was linked to morbidity and mortality databases by Data Linkage WA. A wide range of demographic and clinical factors were examined for their effect on outcome. These included age, sex, comorbidity, severity of illness, organ failure, ICU diagnostic groups, type of admission (medical, elective surgical and non-elective surgical), length of stay in ICU and era of admission (1987-1990, 1991-1994, 1995-1998, 1999-2002). Patients were followed-up to study end, 31st December 2003 or death if it occurred before study end, that is, up to 17 years after the index ICU admission. Kaplan Meier survival curves and Cox regression models were used to examine intermediate and long-term survival for patients who survived to hospital discharge. A comparison of admissions to hospital before and after the index ICU admission was made using descriptive statistics and logistic regression. Throughout the study period survival for the ICU cohort was shorter when compared to the Australian population. This was consistent throughout the follow-up period. The most important determinants of long-term survival were age, comorbidity, severity of illness and diagnostic group but the strength of association varied with the duration of follow-up. Although age, comorbidity and severity of illness increased among the critically ill survival improved over time. Hospital admissions were more frequent after a discharge from hospital that required an admission to ICU than before the index admission, even after adjusting for the ageing of the cohort. This study provides unique information about the survival and other outcomes of patients discharged from a hospital admission that included an ICU stay. The strength of this study lies in the follow-up to 17 years and the more comprehensive range of explanatory factors than in previous studies. This thesis demonstrates that follow-up studies after intensive care should be of sufficient duration to account for the changes that occur in survival over time and indicates the range of factors that should be taken into account when making comparisons of long-term survival.

This research explored the perception of the incorporation of ‘future-self’ for young people (YP) moving from specialist provision for children where the Local Authority have identified the provision as Moderate Learning Difficulties and additional needs, their parent/carers views, and the perspectives of professionals supporting their transition to mainstream further education. The ‘future-self’ approach had its basis in social cognitive theory, as the creation of imagined ‘future-selves’ is thought to influence an individual’s behaviour to aid them to work towards their aspired self (Baker, 2015; Markus & Nurius, 1986; Oysterman & James, 2011). Phase one used a case study methodology using semi-structured interviews to explore the YP and their parent/carer’s experience of transition planning having included the young person’s vision of their ‘future-self’, at aged 16. Materials were designed to aid their understanding using visual support. Phase two gained the views of YP using focus groups as they approach transition out of FE at aged 19 or older into continued training, employment, and on towards adulthood, in relation to inclusion of their vision of their ‘future-self’ in this preparation. This phase also explored the perceptions of the professionals for incorporating the young person’s view of their ‘future-self’ using semi-structured interviews. Interview transcripts were analysed using Braun and Clarke’s (2006) six stage thematic analysis to identify themes in the data. Focus groups were thematically analysed using Ritchie and Spencer’s (1994) five stage analysis. A number of themes were found for the YP at both stages, the parents/carers and the professionals. Findings indicated that the YP are more involved in the transition planning and a range of methods are applied to prepare the YP however there are a number of barriers still limiting the options for the YP such as: lack of choice available, protectiveness of others, low aspirations, failure to explore holistic longer term outcomes, insufficient multi-agency involvement, overreliance on parents, and the need for more effective strategic planning and awareness of the systems around the YP. The findings from this research indicate that applying a ‘future-selves’ approach for YP as a method to generate future aspirations to motivate YP’s behaviour has been effective as a tool to add to existing transition preparations. This could act as a way to overcome the currently existing poorer long term outcomes for YP with this population. Based upon this small scale project, further investigation would be required to assess the benefit for a wider population.