Discharge from hospital

On this page people speak about being discharged from hospital after being in intensive care:

  • How people felt about going home
  • The timing of leaving hospital
  • Emotional encounters when leaving the hospital buildings

Before they are discharged from hospital, patients need to meet certain criteria, and be judged well enough to manage at home without professional help from nurses, physiotherapists and occupational therapists. Among many health care professionals working on the ward towards an individual’s recovery for hospital discharge, physiotherapists support patients on the wards to regain their strength, and assess whether they are ready to be discharged from hospital. Physiotherapists work closely with Occupational Therapists, who assess the needs patients are likely to have once home and how these are going to be met. This might include practical changes for the home, such as commodes or arranging space to sleep downstairs. Some patients may be assessed on the ‘activities of daily living’ they will need be able to do for themselves, such as cooking a meal for themselves or moving around their home. The environment patients go to after leaving hospital plays a role in this assessment: and where appropriate, some need to be able to pass a walking test or to climb stairs without their blood oxygen levels dropping too low.

Chris asked about discharge criteria as soon as he was moved to the ward.

So, then they moved me down to the respiratory ward, I remember I was taken in, the doctor came – this is about eight o'clock in the evening – the doctor came straight in and said to me, hi, you’re on a respiratory ward, you’ve had this and this, do you have any questions. And I said to him…I remember I said to him, yeah, I’ve got one question, how do I get home? And he said, you need to be able to breathe by yourself and walk 30 metres. And he said, thank you, you’re the only person who’s ever asked me that. Because that’s what was in my head, that I wanted to get home then. And then, yeah, I was put on a ward with four of us. I settled in that night.

It was, again, the staff were amazing, nurses were there all the time checking on you, the doctors were there every day. And just I think I got in – I was on 40 per cent oxygen – the day later they moved me onto ten per cent oxygen. The next day the doctor said, try him with no oxygen, and I managed to have two days where I didn’t need any oxygen.

And on the third day of no oxygen, I managed to pass a walk test and be sent home, which was absolutely amazing, because there was a time when you’re in intensive care when you think you’ll not come out of there. But, yeah, when the doctor came in and said, are you able to call someone to come and collect you, that was amazing. So yeah, so that’s pretty much it.

And then you came home?

Yeah, then I came home… When you’re in hospital they got me to pass a walk test of walking 30 metres, on a flat surface, which is fine.

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Patients are discharged from hospital when they are considered well enough to manage at home, either on their own or with the help of family, friends and/or professional carers. As someone may still be very weak, patients will be discharged from hospital with a treatment plan which may include nursing care, or continuing physiotherapy (in person, or, if that is not possible, then online via video). Some people are discharged to a rehabilitation unit or a nursing home, where they receive additional care and support.

Blood oxygen levels, also called ‘saturation levels’ are one way of indicating of how well the body is coping in transporting oxygen to its vital organs. Somebody who is well has blood oxygen saturation levels between 95% and 100%. In many hospitals, a value of 92% indicates the threshold that a patient needs to reach before being allowed to be discharged from hospital.

People are generally discharged from hospital with a treatment plan which may include and may continuing physiotherapy in person, or, if that is not possible, then online via video. Health care professionals are still learning about the long-term effects of Covid. It is expected that many will continue to need support with fatigue, neurological issues – for example confusion or ‘drop foot’ – and breathlessness, possibly due to scarring in their lungs.

Feelings about going home

Many people we spoke to had been in the hospital for a long time, and most had not been able to see their family members and friends in person. They were desperate to go home, to ‘regain a sense of normality’ and to be with loved ones, even if they felt uncertain and fearful about managing without the support of hospital staff. While most were discharged home, a few people went to rehabilitation units before going home. (See for more information about hospital discharge after ICU’).

Chris asked about the criteria for his discharge as soon as he got onto the ward. Emma noticed that the hospital was getting busier during the second wave of the COVID-19 pandemic. This motivated her to try to walk so that she could go home. Some patients felt ready to go home before their doctors felt they could. Geraldine wanted to go home so that she could see her daughter who was also in hospital, but did not realise how ill she still was herself.

Emma was motivated to try and walk to be able to go home: “Every day I’d be like, what do I need to do to get home, how do I need to…what boxes do I need to tick, because the hospital we knew was getting busier and busier and busier, and the poor nurses were working flat out, so you knew, and in my head I’m thinking, I’ll be happier at home, because once you’re home, it’s your own environment, so they wouldn’t tell me what I needed to do, but I knew I just needed to do something … Every day was like, I went, can I have a frame, I need to try and walk, so they’d come in and they’d say, right, today we’re going to do this.”

Geraldine did not realise how weak she still was and wanted to go see her daughter, who was in another hospital.

That’s the first thing I tested: whether I can move my legs. And I could move my legs. So, if I can move my legs, sitting down, maybe I can get up and walk out. I can discharge myself. That’s what I thought. And then the doctor said…asked me how am I, so I said I’m okay. And then he asked me several questions. I don’t know what I said. And then I think I must have said I want to go home, and he said no, you can’t go. I was getting alarmed, and he said you can’t go. I said why, why can’t I go. And then he said you are not well. You need to stay some more. I tell you I was stubborn. I was very stubborn that day. I said no, I don’t want to stay; I want to go and see my daughter. She’s in the hospital. I want to go. He said you can’t go.

This is why you wanted to go quickly?

Yes. So that was it. So, I think from that day onwards every nurse, doctor, coming in, I’m telling them I don’t want to stay here. And I can’t sleep here. That’s it. I told them I can’t sleep here because they make a lot of noise. All the long corridor in the community, you know, hospital, they are… It’s a long corridor to walk anyway, from the ward to the door, the way out. And then I want to go home. I didn’t want to stay. What was the point of staying here? But anyway I, sort of, argued…it’s like I feel like I’m arguing with the doctor, which I normally don’t do. I was getting a bit annoyed. Why am I staying here for? The doctor said you are not well; you can’t go now. You, on the 12 April, I was telling doctor look, I want to go home. My home is nearby. I told him why don’t I just…I’ve got my freedom pass, I can just hop on the bus. I thought I will be able to just go, like how I was before. I can walk.

And did you at any point realise how weak and…?

I didn’t think of anything that day. That day when I woke up, I wanted to… All my thoughts, my strength, whatever was left over, geared to see my daughter.

And I thought I could walk out, and I didn’t realise. Actually the…because I was not using the stairs in the hospital anyway, they have lifts so you can go down and come up and it’s really easier. But I didn’t bargain with steps. With ambulance always taking the patients home anyway. Then they are [inaudible] because the doctors are saying it’s a public holiday. I remember it so vividly, even today. Public holiday, we can’t…because they had to pay for ambulance guys.

Yeah, so you stayed two days more.

That’s it. Two days more. I didn’t mind about two days more. It is okay, fantastic, I’ll be home. But I didn’t bargain when climbing up the stairs. Then [when I was discharged] I realised I’m in a bad way. A really bad way.

Yeah.

Maybe it happened to everybody, poorly Covid patients. I don’t know because I had arthritis, neuropathy, what other things…stuff going on, aches and pains. It’s only my legs that were weak. Very weak.

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The timing of leaving hospital: waiting for discharge and leaving hospital early

Some people had to wait for a long time until they were well enough to be discharged which they found frustrating. Carl’s confusion continued for a long time, and he was unable to answer the questions that staff asked him each morning. Brian remembered becoming fixated on his blood oxygen saturation levels, indicated by the equipment he was connected to, whilst he waited on getting well enough to go home: “you’re just watching all of this and you’re figuring it all out, you know, right from the oxygen levels, on that CPAP (Continuous Positive Air Pressure).” Chris was not discharged until he passed his walking test.

Carl was only discharged when his confusion disappeared. Coming home was a relief.

I just kept pushing. I remember every morning they’d come along and ask me questions: what year is it? who am I? where am I? I didn’t do very well. Every day I couldn’t really remember the name of the hospital. I think I could remember my name. I couldn’t always remember my date of birth. I probably got the date wrong every day or the year wrong. It felt like I never seemed to get the year right because I was just very confused every morning because I’d just had a whole heap of dreams all night long. And that’s why I was saying earlier I was not letting the, I didn’t want to have any more drugs because I felt I’d fail the questions in the morning and then I wouldn’t get out of here. And I felt like I’m never going to get out of here because I can’t answer the questions. I remember sitting there all day long trying to memorise all the questions, which were only like, where are you, what year is it, what day is it, or something like that, really simple, but I just couldn’t remember. I often couldn’t remember my surname and things like that. My brain was just all over the place.

And to the point where eventually one morning they came round, and I could remember everything. But I sat there literally in the morning trying to memorise it and stuff. I couldn’t write anything down because I couldn’t use my hands or anything.

It’s quite weird how you can lie there. I’m somebody who’s got several businesses; I’m flat out, non-stop, I hardly sleep at night, I’m flat out all the time, to just lie in a hospital bed and look at the ceiling. I was next to a window but couldn’t really see much out of the window, only the sky, but I’m looking out everywhere. And I’m just to be almost watching the world go by for hour after hour after hour. If I could turn the TV on, I couldn’t because I didn’t really know what I was doing with it, I don’t think I’d have watched it because it was just too much to concentrate. I couldn’t concentrate on anything. I felt really, really weak and I was just unsure.

And it was a nice feeling to be able to get out of the hospital eventually and get home. Arriving home, I could still hardly walk. I think probably, I don’t think they really wanted to let me go out of hospital; I was kind of pushing and pushing and saying I was okay. Literally in hospital I was saying every day, can I go home, can I go home, can I go home, desperate to get home. And eventually to get home was the relief. And sitting down having the family around me I just can’t describe to you how it boosted me up, even though I couldn’t really walk very far. I was still quite confused about the whole thing. But from that moment I never had any more dreams, no more hallucinations, nothing, it just instantly stopped.

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Some of the people we spoke to had to wait for something other than improvements in their condition before they could be discharged from hospital. Moazzam and Ann both had to wait until a stairlift could be organised by the occupational therapists and installed in their homes. Mark had to wait until a bed in the rehabilitation unit became available.

Ann was eager to go home but had to wait until a stairlift had been installed in her home.

I thought, one…when I was in hospital, itching to come home, I remember the doctor saying, we can’t let you go until you have a stairlift fitted; because even with the physiotherapy, they have, like, these two or three step things that you have to try and get up and come down. Now I wasn’t so bad coming down, but it really was an effort to go up. Even though I have made strides in that department, but even when I was walking…and I think I pushed myself because I just wanted to sort of show them that I could walk so could they please let me go home. But it wasn’t as clear cut as that. So, we had to have a stairlift fitted before they would let me come home from hospital. Which I am grateful for.

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Sometimes, patients may leave hospital early, before the clinical team are sure they are ready. For some people, early discharge was deemed beneficial specifically to allow a return to familiar environment and to the company of their family. Where family members had a clinical background, this made earlier discharge from hospital easier, as they knew what to expect and could easily take on care responsibilities.

Paula’s health care team decided that going home could help reduce her confusion.

And they…I stayed on there for a few days and then it was decided that I'd probably be better off at home because of my confusion, I'd be better off at home and obviously Becks [partner] could look after me. And I was there telling them yes, I can do this, and I can do that when I couldn’t do anything, but I was so desperate to get out of the hospital because I was…because you just become fixated on if you are in the hospital, and you are in with germs. And that's what it like when, you know, Becks goes to work in it now every day and as soon as she comes in, she puts her uniform in the wash and it's washed, but it's…it's a really strange time, it's been strange. And I did…I was better when I came home, I was better in my own home and with familiar, you know, with Katie and Becks around me, but even, do you know what, it still feels like yesterday, it really does feel like very raw, very raw.

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At peaks of the pandemic when hospital numbers were high, some patients were discharged while still very weak, to allow for others to be admitted. Many patients we spoke to were dependent on others to help them (see also ‘First weeks at home’).

While most were happy to go home from hospital, it was also a frightening transition. Emma “felt really vulnerable being out in the big bad world without a medical professional sitting on [her] shoulder”. Sadia’s father was unable to manage at home, and he was readmitted to hospital.

Wendy was discharged early which meant she had not received the physiotherapy that would have enabled her to go up the stairs in her home.

How did you feel about leaving the hospital?

How did I?

Feel about leaving the hospital?

Oh no, I was quite happy to do that, yeah, no, I was happy to get home, yeah, very happy to get home. The one thing I didn’t do before I left hospital, because what happened was, there was a whole influx from Kent and London coming in so anybody that was okayish was sent home, but I hadn’t done any of the physio that you do before you leave hospital. And I know the physio was really quite cross about it because I’d seen her on the Friday and she said, right, I’ll see you Monday and then we’ll start doing a bit more walking with you and a few more stairs…and we’ll start the stairs. And I knew that you can’t go home until you’ve done the stairs because of previous things. And so, on the Sunday when they said, is there anybody at home, I said, yes. Can anybody come and pick you up? Yes. Right, you’re going to go home this afternoon then. Fabulous, you know, I thought, great.

And then I got a phone call from the physio on the Monday to say…you know, she was a bit upset that that had happened because I hadn’t done all the things that I should’ve done. And I’d only been off of oxygen for 18 hours so she was a little bit concerned about that. I was okay and then in the end the oxygen got installed here anyway because I did need that to keep me…stop it going so low.

So, on the Sunday when I got home, of course I had to go up…we’ve got stairs, I had to go up the stairs. Well, it nearly killed me. I got halfway up and just I was like [non verbal speech] like this, I couldn’t breathe. And I got to the top of the stairs and, you know, I said to my husband, just get me a drink of water. I had a drink of water and I had to just sit on the bed. And again, you know, it’s the breathing things that I’ve been taught through my ILD (Interstitial Lung Disease). So, it’s just sort of sit down, you know, use your diaphragm to get it all calmed down and breathe in and breathe out. And just had to sit there then for a good ten minutes just to get my breath back, and that was scary, that was scary.

And so, then I made sure that I had a bag so that anything I needed I just took downstairs so that I didn’t have to go up and down the stairs in the day. And then [name] when I started to get better, that became one of my exercises to go the stairs two or three times a day to help with my fitness. And now I can almost run up the stairs so that’s not quite so much of an issue. But that was a shock; that was a huge shock. I mean, I didn’t even think about, you know, I got home at about four o’clock, didn’t go to bed till about half past ten and it didn’t hit me until actually went to go up the stairs. So yeah, that was a bit of a, ooh how am I going to do this?

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Michael was offered a transfer to another hospital where he could improve further, but he did not want this. In contrast, Mark was to be discharged home, but insisted on going to a rehabilitation unit instead.

Michael did not want to spend any more time in hospital than was strictly necessary.

So, in that respect I think, rather than taking the baby steps I looked more towards taking as many steps as I could at one go. So, because of that probably my stay in the hospital wasn’t as long as at first they thought it would be. Because I remember even must have been at a week or so after I went in the Covid ward they had asked me if I wanted to go to another hospital for more…well, it’s not rehabilitation, but, you know, to get better. And to me that wasn’t something I would have considered doing.

Why not?

I don’t know, I just…after spending four weeks in the hospital I just wanted to go home. I mean I should be more familiar with hospitals because as a child I was very ill and did spend a lot of time in hospitals; so maybe that was stuck in my memory to the point that I didn’t want to spend any longer than I need to.

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Emotional encounters when leaving the hospital building: being clapped out and family reunions

Some people were clapped out of hospital by the health care teams who took care of them. These were emotional moments for all – staff, patients and family members alike – and could hold significance more widely. Some hospitals filmed this and uploaded it onto their social media channels or in local newspapers to provide some positive news about Covid.

After getting all the necessary equipment ready for Shaun to come home, Deborah went to pick him up. He was clapped out of the ward.

So, I think we went into the ward on the Monday, and then on the Thursday, we had all the stuff delivered that we might need, like a wheelchair and a shower chair from the hospital, the occupational therapists, they were very good, they phoned me and said, what would I need? And then I went to pick him up and they clapped him out of the ward, which, I was so emotional, a, I didn’t even press the record button, and I think I dropped my phone on the floor, ‘cause I was just, aah…and then when I saw him, oh my gosh, getting him in the car. He was a bit frightened coming home, obviously, but getting him in the car and all the bumps we were going over, and he was so frail, he’d lost 20 kilogrammes of weight. Yeah, he was skin and bone.

And when we got him home, it was 24/7 looking after him. He was so frail, he couldn’t sit down, he had bedsores, his legs were so, everything, the whole, he looked like a walking skeleton. But, we were just so pleased to have him home. It was hard, because he wanted to progress, but he was so emaciated, there was just no fat on him whatsoever.

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Several people described how being picked up from hospital was a very emotional moment. It meant they were recovering, and they could see and be close to loved ones again.

When Chris was discharged from hospital, seeing his family again was very emotional.

So, you’ve mentioned a bit already, but how did you feel about leaving hospital?

So, I did my walk test, and the doctor said to me, oh, yeah, we’re sending you home. And it didn’t really sink in straightaway, and I said, okay, thank you, bye. And he went, and then went on to the next patient. And then about ten minutes later one of the nurses came up to me and said, are you excited you’re going home? And I thought, it hasn’t really sunk in yet.

And then I phoned my mum, and…I phoned my mum. And I was just talking to her normally, and I said, oh, by the way, Mum, er, are you free in a couple of hours to come and collect me? And she started crying. And I started crying. And she ran and grabbed my dad and said, Chris is allowed to come home. And, yeah, the…so the…they were…the nurses said to get your stuff together, they got my medication sorted from the pharmacy, because I’m on, for 84 days I’ve got to take blood-clotting treatment, I’ve got to inject myself twice daily still, and so they had to get all that for me.

And my mum and dad were able to pick me up two hours later. And they, oh, I did…the problem was that they parked in the car park; and walking only 30 metres to then being expected to walk 300, 400 metres to the other side of the hospital through the car park. So, they actually put me in a wheelchair, wheeled me to the door, and…I was able to hug my mum again, which at one point I didn’t think I could. So yeah, I just burst into tears, she did; and yeah, I just remember hugging my mum and dad for ages.

And then a nurse wheeled me to the car. I managed to get out for the last bit and walk, and just, yeah, just hugged my mum and dad for ten minutes. And then I came home, my sister was waiting, and she burst into tears, I did, and yeah, it was just…thinking that you’re never going to see someone again, to then be able to hold them… Yeah, it was really emotional.

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