Intensive care: Patients' experiences

High Dependency Unit (HDUs)

Some hospitals have High Dependency Units (HDUs), also called step-down, progressive and intermediate care units. HDUs are wards for people who need more intensive observation, treatment and nursing care than is possible in a general ward but slightly less than that given in intensive care. The ratio of nurses to patients may be slightly lower than in intensive care but higher than in most general wards. Some hospitals have a combined ICU and HDU or a certain number of beds in ICU given to HDU patients. In these cases, although a person is not moved to another ward, the level of care is slightly reduced as s/he is no longer in such a critical state. People spend varying lengths of time in HDU, depending on the nature of their illness and the demands on the unit. Some hospitals in the UK have no HDUs, and in these cases people are usually transferred directly from intensive care to a general ward.

"Before a patient is discharged from intensive care, s/he should have another health check (called a short clinical assessment) to identify:
  • any physical or psychological problems
  • the likelihood of any problems developing in the future, and
  • their current rehabilitation needs
  • If the health check shows that the patient could benefit from more structured support, s/he should be given a more detailed health check (called a comprehensive clinical assessment) to identify their rehabilitation needs."
- NICE CG83 (2009)

Here people talk about their experiences of High Dependency Units. 

Hospitals use HDUs in different ways. Some people are admitted before and after planned surgery. Many, who are admitted to ICU as emergencies, are moved to HDU immediately after leaving intensive care. For some of them, especially those who'd spent over a week in intensive care, transferring to HDU was a sign of progress. It meant they were improving, gradually establishing more normal eating and sleeping patterns, and a step closer to going home. Some people described the progress they made in terms of their abilities to grip, walk and communicate. Many said they felt much more alert and orientated once they were in HDU. One woman was discharged immediately after being in HDU. She and her partner both noted the progress she made once she was transferred. A few people remembered having physiotherapy in HDU.

When people felt they had a high standard of nursing care and treatment in HDU, they regarded their transfer as a positive move in the right direction. Some people, however, felt they'd been transferred much too early. Others had mixed feelings about moving to HDU because they'd felt so 'safe' and secure in intensive care. One woman said ICU was like a 'security blanket' because a nurse was by each patient's side almost all of the time. Some felt anxious as they were improving and found it difficult to cope with other sick patients in close proximity.

One woman was unhappy with some of the nursing care she'd had in intensive care and said she was angry when she went to HDU. She felt isolated and that nurses didn't believe what she was saying.

When hospitals don't have HDUs, patients are transferred directly from ICU to a general ward. Some people who had experienced this expressed their concerns (see 'The general ward: care and environment').

Some people recalled being visited by outreach nurses. Outreach services aim to enhance the care of ICU patients on the wards and make the transition easier. Outreach nurses also aim to avert re-admissions to ICU from the wards and to share their nursing skills with other staff in the hospital.

Last reviewed August 2018.

Last updated November 2012.


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