People are transferred from the intensive care unit to a general ward when medical staff decide that they no longer need such close observation and one-to-one care. For many people, this move is an important step in their progress from being critically ill to recovering. In the UK National Health Service (NHS), general hospital wards are very different from ICU, the biggest difference being fewer nurses to look after many more patients. Nurses can be called with a buzzer by the bed but may not come straight away and some people who have become used to intensive care find this difficult. Here people talk about what it was like for them when they left ICU and went onto a general ward. Their experiences range from those who found this move the most difficult aspect of being in hospital, to those who were happy to be out of intensive care and on to the next stage of their recovery.
Preparing for the move to a general ward
Many people we interviewed felt they were unprepared for the kind of care and busy atmosphere of a general ward and said that the move had made them feel anxious and insecure. Some people wished they hadn't been moved to a ward until they felt better able to cope and look after themselves. Many were worried because they were extremely weak physically, relatively immobile and often completely dependent on nurses for all their care. Some said that it sometimes seemed to them that nurses in the ward didn't understand how insecure they felt when they left ICU, and some nurses had unrealistic expectations about how much they could do for themselves (see 'Physical and emotional experiences'). Many also said that there were too few nurses to patients, one man saying he felt 'forgotten'. Some carers said they were shocked when they needed to help with aspects of personal care and hygiene on the general ward.
"Before a patient is discharged from Intensive care or the High Dependency Unit s/he should be given another health check (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
The healthcare team should talk to each patient about his or her rehabilitation goals and rehabilitation programme, both of which should take into account the results of the health checks and be tailored to the individual’s needs" (NICE CG83).
In ICU, people received one-to-one care by specially trained nurses, but on a general ward several people said they were 'one patient among many' and some found this a difficult adjustment. One woman, with spina bifida since birth, recalled how her parents insisted she have her own nurse on the ward because she would need much more help than others. Some felt that the ward nurses were less trained than those in ICU. One woman was upset when nurses on the ward didn't know how to deal with equipment to drain her wound. Others described the wards as busy places, and said that nurses were sometimes so busy with other patients that they felt 'abandoned'. Yet others disliked having to 'buzz' the nurses for help and felt they were bothering or 'mithering' them.
People described how difficult it could be to get their needs met on the general ward; some attributed this to a 'lack of co-ordination' on the ward itself. Others felt it was 'just the way it was' because of staff shortages in the UK National Health Service. Some were upset when they waited for things that never arrived, including meetings with medical staff, food and physiotherapy. Others said communication was poor between ICU staff and those on the ward, and occasionally - as when nurses on the ward were unaware of their medications or dietary restrictions - they felt this had affected their treatment and progress.
Being left unattended for varying lengths of time when they needed to go to the toilet or be washed or cleaned could be hard to cope with on the general ward and some said they felt themselves 'go downhill'. One woman said she felt isolated and disappointed when she had to have a catheter re-inserted. For others it was the 'little things' that were overlooked - 'that little extra bit of kindness' - which made the difference between feeling 'treated' and feeling 'cared for'. Some of these people thought that all hospitals should have a High Dependency Unit to bridge the gap between intensive care and the ward (see 'High Dependency Units (HDUs)').
One man, who had sickle cell anaemia and chest pains when he went into hospital, said that his family questioned whether the standards of care on the ward had actually triggered his pneumonia in the first place and led him to intensive care.
Some people were concerned about language barriers between patients and staff.
Some people felt that the ward environment hindered their recovery. Many said that the lights prevented them from sleeping properly as well as noise from other patients and their visitors, including arguments.
One man said that his partner noted many instances of poor hygiene and cleanliness on the ward.
Improvement and recovery
For some people moving to a general ward was associated with making progress and seen as an important step in the right direction. They quickly accepted that there were fewer nurses to patients, and a few said they were more comfortable with getting less attention. Several noted that, although the care was more personal and 'intensive' in ICU, they understood the constraints on the ward, on the UK National Health Service more generally, and accepted that the wards would be 'busy, short-staffed and under-resourced'. Overall, they were satisfied with their care and focussed on recovering. Some, who'd found ICU lonely, were pleased to be able to look around and talk to other patients on the ward. Others said they were satisfied with and grateful for all the care and treatments they were given while they were on the ward.
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. A few people recalled being visited by outreach nurses.
Last reviewed February 2013.
Last updated November 2012.