Hospital discharge and rehabilitation

Patients are transferred from the intensive care unit (ICU) to a general ward when medical staff decide they no longer need such close observation and one-to-one care. For both patients and their relatives this move is an important step in the patient's progress from being critically ill to recovering. In the UK National Health Service (NHS) general hospital wards are very different from intensive care, the biggest difference being fewer nurses to look after many more patients. Instead of having one dedicated nurse as they did in ICU, each nurse in a general ward may be responsible for caring for up to nine patients. Nurses can be called with a buzzer by the bed but may not be able to come straight away. Both patients and relatives can find this difficult if they have become used to intensive care.

Here people talk about the progress the ill person made on the ward until he or she was discharged from the hospital back home or to a rehabilitation unit. 

Many people said that, gradually, the ill person had made progress and could do a bit more for themselves every day, including moving, gripping, lifting arms and legs, and walking. For a few people, the move to a ward was difficult because the patient had still been confused and hallucinating. Some recalled how the patient had become more aware and alert once on the ward. Others explained that the ill person had been hallucinating after coming round in ICU but, since being on the ward, the hallucinations had been wearing off or had worn off completely. 

Their relative had a lot of hallucinations while on the ward but became more aware as time went on.

Some people talked about the progress their relative had made after having serious head or brain injuries. Many described how the patient had had mood swings or had become angry, agitated or frustrated very easily. As well as recovering physically over time, they'd also had to recover mentally as well. This can take time and many relatives explained how, every day, the patient had made small progress and this had been extremely encouraging. One of these people said her husband had become very depressed and aggressive on the ward and, at first, she'd worried about his recovery and what the future had held. Every day, however, he'd been able to do a bit more for himself. 

At first her son would often get angry and aggressive but, gradually, he became more aware and started talking and walking.

Although their son was very weak, one day, completely out of the blue, he got up and walked across the ward unaided.

Some people said that, once the patient had started improving and becoming stronger, they'd needed surgery to help with their recovery. Although it is quite rare for patients to need amputations, one patient's serious infection had spread and she'd needed two leg amputations. One woman said she'd been extremely surprised when doctors told her and her husband that, during the time he'd been sedated in ICU, his body had recovered by itself and the operation he'd been waiting for and dreading was no longer needed. 

Their relative had an infection and, when it spread, she needed to have more surgery and another leg amputation.

Her husband was anxious about having surgery but they were both relieved and happy when doctors showed them his x-rays and told them he no longer needed it.

One man said that, although his father had been making good, steady progress, he was still on the ward. Doctors hadn't yet known exactly when he would be well enough to go home because, when he was strong enough, he'd need another operation. 

His father was likely to stay in hospital for quite some time and would only be discharged after having a further bowel operation.

Some people praised the support the patient had been given by physiotherapists, who'd helped the ill person walk using a Zimmer frame, stick or by supporting him or her on both sides. When the patient was strong enough, they were discharged 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 they 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. 

Rehabilitation 

Some people said the ill person stayed on the ward until they could be transferred to a rehabilitation unit either in the same hospital or another one, where they would receive 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. 

Her son walked for the first time since his accident when he was in a rehabilitation unit and she praised the support he received from a physiotherapist.

Their son went to a rehabilitation unit during the day and came home in the evenings, and they were pleased when he was able to have speech therapy.

One man said his wife needed so much care on the ward, he talked to several doctors and they'd agreed to transfer her to a rehabilitation unit, where she would have the support she needed to become mobile again. She also needed a lot of help with her personal care because she'd had many serious bowel problems.

His wife needed a lot of support and, in the rehabilitation unit, nurses had time to spend with her and physiotherapists helped her become mobile again.

One woman said her brother was still attending a rehabilitation unit during the day. He had been there for several months and had been making steady progress.

Her brother made huge progress at the rehabilitation unit and is now independent enough to live alone at home and visit the unit every day.

Last reviewed November 2010.