Patients will experience a wide range of physical changes (most temporary) as a result of their intensive care admission. These are the most common changes that you may see when the patient is transferred to the ward:

• Muscle loss and weight loss causing weakness and fatigue

• Breathlessness - some patients may have spent a prolonged period on a ventilator which results in respiratory muscle weakness

• Weak voice as a result of the endotracheal tube

• Dry skin and thinning hair due to critical illness

• Peripheral nephropathy making it harder to pick up objects

• Changes in smell, taste, hearing

• Delirium or poor sleep / nightmares

• Problems with bowel and bladder control

It can take up to 18 months for a patient to recover from their critical illness. Many patients will have experienced a significant life event by being admitted to intensive care. This can result in feelings of fear on step down to the ward. It is important that we support their psychological recovery as well as their physical recovery. These are some of the most common psychological effects of critical illness:

• Feeling upset and tearful as they process their experience

• Fatigue which may lead to loss of motivation in recovery

• Poor sleep, mood changes, irritability

• Feelings of guilt

• Worried about getting unwell again or fear of dying

• Worrying about recovery and the effect this may have on their life, family, work or finances

• Not understanding what has happened to them and how ill they have been

Transfer from ICU to the Ward

Patients who have experienced a critical illness are at greater risk of deterioration and therefore need to be closely monitored:

• 10% of patients discharged to the ward will be re-admitted to ICU and this is associated with poorer outcomes

In the first year after hospital discharge following critical illness: 

• over half of ICU survivors visit an emergency department

• a third are readmitted within 30 days of hospital discharge

• up to 60% are readmitted within a year.

The handover process between ICU and the ward is an essential process to ensure no information is missed.

Ensuring the following are considered will help patients make the transition to the ward and their ongoing recovery:

• Orientation to the ward environment for patients and families and what to expect whilst on the ward

• Ensure that the ward team involved in the patient's care understand what they have experienced during the ICU admission

• Monitor for delirium and refer to Delirium (DAD) team if appropriate

• Monitor nutritional intake and refer to dietitian if required

• Psychological care: Monitor for any anxiety or distress, discuss with the iMobile Critical Care outreach team a referral to ICU psycho-social team

• Ensure medication is prescribed promptly on admission to the ward and that the patient has a medical review on step-down to the ward

• Discharge planning: Preparing the patient for discharge home and supporting them in their on-going recovery

ICU Steps - intensive care support charity