Intensive care: Patients' experiences

Discharge and moving on

People who have been in the intensive care unit are usually discharged to a general ward when doctors consider that they no longer need such close observation. People are discharged from the general ward when they are strong enough to look after themselves or be looked after at home. People admitted to ICU because of planned surgery often spend only a few days in ICU and on a ward, and then leave. People admitted to intensive care as emergencies tend to spend longer in hospital. They may be very weak when they go home but no longer need specialist care. Some of them go to a rehabilitation unit after the general ward; others go home directly. Here people talk about leaving hospital after being in intensive care.

The National Institute for Health and Care Excellence (NICE) recommends that:

"when a patient is well enough to leave hospital, s/he should have an assessment (called a functional assessment) to identify any physical, sensory or communication problems, emotional or psychological problems, and any social care or equipment needs that s/he may have. The healthcare team should consider how the results of the assessment could affect a person’s daily life when s/he leaves hospital. Rehabilitation goals should be discussed and agreed with each patient (and their family/carer if they agree). The healthcare team should organise any referrals for further care or rehabilitation before the patient leaves the hospital. The patient should be given a copy of their critical care discharge summary, which is a letter sent to the GP with details of the patient’s critical care stay and the contact details of the person coordinating his or her rehabilitation and rehabilitation plan. A member of the healthcare team should make sure the patient (and family/carer if appropriate) understands what his or her  continuing rehabilitation will involve and what other things s/he might face during recovery after hospital discharge"
-NICE CG83 (2009).

Rehabilitation after being in a general ward
After being in intensive care and then a general ward, a few people were transferred to another hospital or specialist unit with rehabilitation facilities. Here they received extra care and treatment before going home, including physiotherapy and occupational therapy. Occupational therapists (OTs) help people improve their ability to perform tasks in their daily living or working environments. This includes helping people to dress themselves, cook and eat. Everyone admitted to a rehabilitation unit needs extra support to become more independent, for example with their mobility if they'd had an extended stay in ICU or because they were very weak even before needing intensive care. Before patients go to a rehabilitation unit, a multidisciplinary team, including physiotherapists, doctors, nurses and occupational therapists, assess their needs. An occupational therapist may even have visited the person's home to see what aids they might need to help them when they are back home, such as stair rails. Some people we talked to knew about this process, others didn't. Patients and their families may feel anxious about the transfer to other areas of the healthcare system. How long a person spends in transitional care varies, depending on how much support he or she needs. Some people talked about their experiences of rehabilitation and how they'd been encouraged to regain both physical and mental skills, using Zimmer frames, memory exercises, puzzles and other tools.

One man we spoke to had recently been discharged from a ward and was back home He was waiting to go to a rehabilitation hospital where he would be cared for during the week and return home at weekends. In the meantime, his wife and district nurses were looking after him, and he was pleased to be at home for a while before going back into hospital again.

Discharge from the ward and going home
Before someone is discharged from hospital, medical staff will have discussed their needs and made a discharge plan. Each hospital follows guidelines and will discharge patients only when doctors feel patients are well enough to manage at home with the help of relatives or by themselves. Most people need to be well enough to walk and climb stairs before they can go home. Physiotherapists and other medical staff check and ensure that a patient can do these before discharge.

Most people we spoke to were discharged after being on a general ward where, with the support of physiotherapists and other staff, they regained enough strength and mobility to be considered well enough to go home. Many people said they had been uncertain about how strong they'd need to be before they'd be allowed home and when that would be. Several said they had asked doctors, nurses and physiotherapists when they'd be allowed home, and didn't know who would decide and on what basis. One woman had been discharged from a High Dependency Unit because her partner could look after her at home. Others were allowed to go home when they were strong enough to walk up and down stairs in hospital.

Some people said that, before they could be discharged, an occupational therapist assessed what their needs at home would be, such as hand rails and bath aids.

Doctors discharge people only when they feel they are not at any risk of deteriorating. Some people, though, choose to leave hospital without being formally discharged. This is not usually recommended because a person may have complications or problems at home. This could hinder recovery or lead to new problems, and sometimes re-admission to hospital. One woman, a nurse, said she had discharged herself because she felt she'd recover better at home.

A few people said that, when they were discharged, relatives took them home from hospital. Some were disappointed to have no help to gather belongings, carry medications and arrange transport.

Some people talked about their feelings when they first came home, after having been in hospital for some time. Others described how family and friends welcomed them.

Last reviewed August 2018.

Last updated November 2012.


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