When the time is approaching for patients to move on from the Intensive Care Unit and embark on the next stage of their recovery, we begin to make arrangements for discharge.  This may be to our High Dependency Unit, HDU, which is situated on Aspen Ward in the Duchess of Kent Wing, or to another medical or surgical ward in the hospital.

 

Destination wards after Intensive Care

The consultants make a decision on the timing and the most suitable destination for a discharge based upon an assessment of each patient's ongoing needs. For example, if somebody has been very unwell needing organ support for a while and would benefit from an extended period of close monitoring under our care before going back to the ward, we may move them to HDU.  If a patient was on Intensive Care for a heart-related problem, we would usually endeavour to discharge them to a cardiology ward where the heart doctors would continue their specialist care and make arrangements for follow-up tests or outpatient appointments. Similarly, if a patient came to Intensive Care after a bone or joint operation, the most suitable destination would be to an orthopaedic ward where the surgeons and a specialist team of nurses, physiotherapists and occupational therapists could work to rehabilitate and prepare that patient for going home.

Very occasionally, it may not be possible to discharge a patient to the first choice of ward immediately, perhaps because that ward is full with other patients at the time. If this is the case, our staff will keep patients and their relatives informed and arrangements will be made so that patients are still seen by the relevant specialists and receive the care they need until that ward becomes available. 

 

Ensuring a smooth transition and continuity of care

Our doctors and nurses write a comprehensive summary of the nature and course of the illness as well as all the relevant details and events of a patient's stay in Intensive Care. This document is filed in each patient's medical notes and forms an essential part of the hand over of care to the medical and nursing teams on the wards so that important information is not missed. In addition, our staff liaise directly with the ward staff about every discharge to give advance notice and emphasise any priorities, helping to ensure the transition between healthcare teams is as smooth as possible.

We try very hard to arrange and complete discharges from the Intensive Care Unit or High Dependency Unit to the wards in daylight hours, with the optimum time being in the afternoons. This ensures each patient is seen by a consultant on the morning ward round and we aim to leave sufficient time before nighttime for patients to settle in on their new ward. Again, very occasionally, this may not be possible due to the emergency nature of the work we do.  If a discharge is needed in the middle of the night to free up an Intensive Care bed for somebody else in a life-threatening condition, our staff will do everything they can to mitigate the disruption.

Finally, our Critical Care Outreach nurses make a follow-up visit to each patient who has been discharged to a ward. As well as providing an additional layer of security and continuity to the discharge process, it is also gives our patients an opportunity to ask any questions they may have thought of since leaving Intensive Care and for our staff to pick up on any newly apparent concerns such as emotional and social wellbeing.