The general ward

When clinical staff judge patients are improving and no longer need such intensive care, they are transferred from the ICU (Intensive Care Unit) to a general ward. Patients are ‘handed over’ to ward staff, with all information on their ICU stay, continuing care needs and a care plan.

This page covers:

  • Transfer to the ward
  • Differences between the ICU and the ward
  • Physical recovery and physiotherapy
  • Emotional recovery

Transfer out of the ICU

When clinical staff judge patients are improving and no longer need such intensive care, they are transferred from the ICU to a high dependency ward, or to a general ward. Often there was a wait between being told that they would be moved and actually being transferred. Some of those we spoke to were transferred to the ward briefly and then on to another hospital closer to home, where they stayed for their remainder of their time in hospital.

These were milestone moments on the road to recovery. Some patients we spoke to were clapped out of the ICU by the staff.

Neil was clapped out of the ICU by the staff to the MAU [Medical Assessment Unit] and then to the general unit after a week.

And when I came out of ICU all the staff were saying, you can’t go yet, we’re not ready. I said, what do you mean, you’re ready? They said, we’ve got to get all the staff ready. And you’re in your bed going to a new ward and they actually applaud you, the whole shift of nurses, healthcare assistants, doctors, specialists, they cheer you out. You turn into a bloody mess. And they also did that for me when I came out of MAU [Medical Assessment Unit], exactly the same thing, in the bed, the whole…every staff applauding me, high fiving me.

Okay, so I’d spent about a week in MAU [Medical Assessment Unit]. And it got emotional when I left because the nurses at the time there were more people dying than were pulling through, and it’s still the same for them and they must be absolutely mentally exhausted. But one nurse said, you’re coming off the ward today, Neil, and I don’t want you to go but you’ve got to go – when do you want to go? I’d better go now because if we stay here, if I keep you for a couple of hours, me and you are going to be in bits, we’re going to be crying all over the place.

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In the early months of the pandemic, support from outside the hospital was tangible on the ward, such as drawings from local schools, and gifts for the staff on the ward.

Paul remembered that his room on the ward was covered with NHS rainbows drawn by local primary school pupils.

Oh, and I’ve just remembered, when I went into this room when I was getting better there was lots of wee posters from the local primary school. And the head teacher had got wind that this hospital I was in in [name place in Scotland] had a lot of people who had Covid and a lot of sick people, so could we all do a wee poster, and it was the NHS rainbow. And they had to draw a wee…not knowing who it was going to get sent to, but one, there was two posters in my room, and I noticed it right away and wondered…well I thought maybe my son’s done it. But it was a school down the road, and it said something like ‘get well soon, hope you make a speedy recovery’ or something, and it was child writing, and it was lovely! It was from the local school.

So, a few months later, maybe a month later actually, I phoned up the school and I spoke to the head-, the secretary – the headmistress was busy – and I said, well, you need to pass on my comment that… I told them how serious I was, and I was in a coma for 30 days. To thank the headmistress and thank every child that had done that, it was a fantastic thing to do. There was tears in my eyes when I read it, just wee boys and girls writing to strangers saying get well soon. I thought it was a lovely thing to do.

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Sometimes, people continued to have dreams and delusions. Carl’s nightmares terrified him so that he tried to ‘escape’.

In his confusion, Carl tried to escape from the ward. Carl felt he would have been less confused had he heard familiar voices.

I dreamt like mad, I’d had all these dreams in the ICU. I felt like I’d been in there several years and everything was a memory, and it was real. I’ve talked about this with lots of people about the dreams and stuff, but it was very confusing. Going back into the Covid ward I didn’t really know, I thought I’d been in hospital and years and years had gone by. I thought I was much older, and I was very, very confused, completely. And I was probably like that all the way to even leaving hospital, I was still really, really confused.

I got into the Covid ward, and you could hardly move really, you couldn’t lift your arms up. And just looking around I felt like I was getting better because when I’d gone in, I couldn’t breathe properly and I’m breathing a lot better. The nurses and everything were really, really lovely, though I was really, really confused still.

And probably partly the dreams that I’d had as well had put all things in my mind, like my parents had died, my wife had left me, just loads of things had happened, my business had gone under, all these things had happened. And I’d been away, the dreams I’d had I’d been tortured, horrible things, really, really horrible things had happened to me, and it felt like they had, and it was really difficult to work out what was going on.

And then obviously I couldn’t talk. I knew roughly where I was, I knew I was in hospital. When people, I don’t think they asked me questions the first day or so, but I know I was hallucinating in the day and at night was horrendous; I was back dreaming different dreams and they were absolutely terrifying. The difference was the dreams I had when I was in the ICU were probably of physical torture and things, lots of things going on, really, really confusing because there were dreams within dreams and they all followed one another. I can still remember them like they were yesterday; I remember names, places and everything. But then when I got onto the ward, they were different: they were more dreams where it was more about mental torture.

But I was still believing, as I say, everything I just said with my parents, my wife and everything, the kids. In fact, I even dreamt that my youngest son had died. Every night it just got worse and worse and worse with dreams. I got to the point where I was so desperate to get out because I just felt I needed to get out of the hospital, the number one thing I need to do is get out of hospital, which is weird because I felt so safe going in. It was only because of these dreams that were messing me about.

And I was starting to become scared of people giving me drugs, so I started to refuse having them, especially at night, because I was terrified, I’d be dreaming. But a doctor came up and told me I needed to have them and that was it, which was quite right. And then one morning I think I got up, I put my clothes on and I tried to escape. But I wasn’t a very good escapee because it probably took me about half an hour to go down a corridor that would take somebody else about ten seconds. I was hanging on to everything for dear life because I could hardly walk. Obviously, they put me back in the bed and put an alarm on the bed.

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For many of those we talked to, the move to the ward was an important step towards recovery. But this new environment also brought new challenges. Gerry was very worried that he would not be able to cope and have to go back to ICU.

For Jenny it was a relief to go to the ward, after being on the ICU for a long time.

What was it like for you to go to the [general] ward after that? Sometimes patients find that quite a big difference.

I was quite relieved to know that I was well enough to go back to the ward because I kept thinking…because they kept me in ICU, I kept thinking, am I ever going to get out of here. And when they said I could go back to the ward, I knew that must have been a good improvement to be able to do that. And then when I got to the ward, you’re still in a separate part where you’re monitored more than…in one bay, you’re monitored more carefully. And then when you improve a bit, then you go to another bay where they don’t have to keep such an eye on you all the time.

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It was often only once patients had left the ICU that they could begin to come to terms with what they had been through and the physical and emotional toll it had taken. This was a long process that continued after leaving hospital (see also ‘Coming to terms with what happened’).

Differences between the ICU and the general ward

General hospital wards differ in important respects from ICU. The most important difference is that there are fewer nurses to look after more patients (see ‘Intensive care: Patients’ experiences/The general ward: care and environment).

Nahied felt less lonely on ICU because a nurse would talk to her. She missed this on the general ward.

And was there any difference in this, in the Intensive Care, and in the general ward?

Yeah, I get few differences, ‘cause in ICU, the nurse was always there sitting next to me, 24/7. The first thing I wake up, I see my nurse there, the last thing before going to sleep, the nurse is there. But that is not in the ward, that was different.

In the ward, you had to call the nurse.

I had to call them, and I felt a bit lonely in the ward. ‘Cause the nurse was always talking to me, and I was listening. And she was talking about her day, and tomorrow’s her day off, and talking to me about her plans about her family. One nurse’s son was getting married, she was talking about that, I remember now. But I don’t get that in the general ward, I missed that.

You felt a bit lonely you say?

Yeah. It was a side room, but lonely, ‘cause no one was always there. When I called the buzzer, a nurse would come straightaway.

And did you have any contact with other patients in your time in hospital?

No.  No other patients, no. Because of Covid, you weren’t allowed. Yeah.  ‘Cause of Covid I wasn’t allowed, and there was one nurse, she made me porridge. I never ever ate porridge. She goes to me, I’m going to put something here, and you’re going to eat it. So, she made it for me, she put some honey and I ate it. It was nice.

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Another important difference is that these wards were often noisy as patients were awake more and aware of fellow patients. Of the people we spoke to some found other patients disruptive to their day or to their sleep; but in some cases, people were a source of support to one another (see also ‘Sources of support’).

Mark found the ward better than ICU because there was fewer sounds from equipment. However, he found some patients on the ward disruptive.

And do you remember being there and how was it…what was it like to be there after being in intensive care for so long?

It was better than intensive care. People don’t realise the beep-beep. [Inaudible] We had one guy, unfortunately, this one guy in the corner, I’m not sure if he had mental health problems or whatever. But he was the only person to leave the hospital to come back. And he’ll come back at 11 o’clock at night, with his partner, I don’t know how she got on the ward. And they’re talking, just disturbing everyone.

And you have to say you don’t get much sleep because you’re on observations every three hours. And in the middle of the night, all you’ll do is literally stretched out your arm to someone and go, go on then, do what you’ve got to do. So, I could put my hand on it, put my hand down. And then someone comes in with an emergency and they’re on observations every hour and you’re next to them. And every hour, all you’ll hear is beep-beep-beep, the machines going off. So, sleep is extremely difficult. So yes, it’s less busy than ICU but you’ve still got your volatility and your characters on wards. I always say to people, hospital at night is a very strange place. Because you have certain characters, they sleep all day, and they wake up at 3 o’clock in the morning. Oh my days. Yeah, no.

You seem to have a good sense of humour about it. But I can imagine that at the time, it feels quite different.

Oh, yeah, you want to strangle them at the time. But I’ve always said it and people go, don’t be so silly [name]. And they go into hospital. [Name], I know exactly what you mean, I had [inaudible]. I go, see. And no, a couple of times I’ve been in hospital, there’s always one person in the early hours of the morning who will wake up and disturb the whole bloody ward. So yeah, had one of those as well. And then when breakfast is coming round, they’re not awake. Where’s my dinner? You missed it because you were sleeping. And they want to just create a total fuss. And then some nice nurse comes and finds them something to eat and gives it to them. Bless. There you go.

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Physical recovery

People who have been critically ill have commonly lost muscle mass due to inactivity whilst sedated or in bed for extended periods. They feel very weak and have little energy. Physiotherapists work with them to help them to regain their strength, giving them exercises to improve their lung function and their ability to stand, transfer between bed and chair, and walk small distances (see also ‘patient experiences of ICU/Physiotherapy on the ward’).

Emma recalled building her strength back up day by day with the help of the physiotherapists.

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. They gave me a couple of days, but you know, today we’re going to do this, we’re going to do that, and I’d be like, right, okay, so we’d sit at the end of the bed, the physio would show me the exercises. Even though it hurt, it really hurt, it was so hard, every…there wasn’t one part of my body that didn’t hurt, and I couldn’t breathe properly. I felt like someone had tied something round my chest, and I had a pain going down the middle of my chest, which apparently was from the ventilator where it goes…the tubes are so…where they go in, it was just uncomfortable and painful. So, everything on me was hurting, but every exercise they gave me, I was doing everything, everything they would say to me about, if you go down to the end of the bed and just…they gave me a frame, just try and stand up. They showed me how to stand up, sit down, stand up, sit down, I’d try and do that, and then each day I’d build it up to stand up, sit down, to sit on the chair, there was a chair there.

And sitting on that chair, I even took a picture, I look hideous. .It's the most awful photo in the world, but I’ve never been so proud that I managed to move from a bed to a chair. I sat on the chair and sent a picture to my husband, and then it went from, you know, getting up from the bed to the chair, to walking to the end of the bed. So, then once I’d walked to the end of the bed, I wanted to get to the other side of the bed. And then it would be the toilet wasn’t far from my bed, so then it was, I want to get to the toilet. And then I’d always have to have someone with me, and once I got into the toilet, it was the getting back from the toilet. Then it was going to the window and then just each day or throughout the days, you just build up and up, and then having less oxygen on.

If it hadn’t have been from having all the physios there and the nurses with that bit more time, because they seemed to have more time than what they did…what I’d assume they would do normally, to get you up and about and get you moving. I don’t think I’d have probably been anywhere near as far along as I was, because they all…they wanted you to get better, not because they wanted your bed. Not because they wanted you out so that they could get home and go see someone, they wanted you to get better. They were all quite passionate, and you could tell if the ones that weren’t, they were just like there to shove your medicine in or…but you know, and that’s fine, isn’t it? If that’s what you choose to take from a job, that’s…but they all wanted you to get…so you could see that they’d come in, and they’d be like, hi Emma, how is it today? Right, what have you done today?

And it was just like that, it was just nice, and they were all friendly, yeah, and I think they actually…they make it, they make it for you, they make you want to…in a very childish way, they make you want to please them. Because of how they’re coming in, you…like one of the days they were going to me, see how many times you can get up and down, up and down. And I knew these two physios, I knew they were coming back. I think they were physio, I can’t…you have physios and you have something else, and they looked very much in their uniforms the same. I can’t think, but I’m sure these were physios, and they’d be like…I knew they were coming back the following day, so I made sure that I was up and sitting in the chair when they came round. Just because I knew what they…and they were like, she’s up and she’s in the chair. And I was like, oh yeah, yeah, I’m in the chair. But yeah, you just wanted to be able to do stuff to please them as well, because they gave you so much, you wanted to be able to show them that you could do it, yeah.

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Patients may start eating again while they are still in ICU; others may only start to do so once they get to the ward. Many may still have feeding tubes in place until they can eat sufficient calories. After the transfer from ICU to the ward, most of those we talked to were still dependent on breathing equipment, particularly at night and after exertion (such as getting up from the bed, or, later, walking to the toilet). Paul and Chris described their difficulties eating solid food for the first time again after being on the CPAP (Continuous Positive Air Pressure) mask or mechanical ventilation.

The Speech and Language Therapists (SLTs) helped Emma to get used to eating and drinking again after mechanical ventilation.

And then I went to the ward, and it’s just from there everything picked up. I couldn’t…I spent a couple of days of not being able to move, physio came in, the SALT team [SLT], is it, the swallow people, SALT [SLT], I want to call them SALT [SLT], where you swallow, you can’t eat, you don’t want to eat, food has got no importance at all. I couldn’t swallow, I was terrified of drinking, eating, anything, because your throat didn’t feel like your own, so to swallow anything, I thought, I’m not going to be able to swallow, it’s not going to swallow, it’s going to go down a different hole, or does my body even remember how to swallow, even having a sip of a drink felt alien, it felt weird. And nothing tasted the same, so I was only drinking water, but it didn’t taste like water.

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Emotional recovery

Once on the ward, many of those we interviewed continue to struggle with the emotional impact of their time in the ICU (see also ‘Coming to terms with what happened’). Some felt anxious and depressed, and these feelings could stay with them for a long time.

Ann felt very anxious when lying down in bed on the ward and at home, because she associated it with death. For a while, she slept only in a chair.

And I realised when I came home, I think the reason why I had such anxiety on the bed, and there were many times during my stay I wouldn’t get into bed, I slept in the chair. And I think my fear was that if I get into bed I’m going to die, like the other people did. At the time I didn’t know, but I did have a very, very big issue with lying down, in all the time when I was able to speak to the nurses, they had to put my bed up straightaway because I couldn’t lie flat, because that’s when I started to really panic. So yes, for most of the duration when I was compos mentis I slept sitting up or slept sitting in the chair. And when they had to help me with bathing, they put me on the bed and they said, we’re going to lower you down. And I remember saying, no, no, no, no, up, up; and I kept saying, up, up, up, up. And they said hold on, we’re being as quick as we can.

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These experiences may be associated with Post-Intensive Care Syndrome (PICS). PICS includes cognitive symptoms, such as poor concentration, forgetfulness and decreased memory; emotional symptoms such as depression, anxiety and decreased motivation; and physical symptoms such as fatigue and decreased mobility. Treatment is possible. Family members may also experience chronic psychological effects of the admission of somebody close to them. This is known as PICS-F.*

Read more experiences of ‘Discharge from hospital’

* Rawal,G.,Yadav,S. & Kumar,R.(2017).Post-intensive care syndrome: An overview. Journal of Translational Internal Medicine,5(2) 90-92.

Support from staff

In ICU (Intensive Care Unit) people are cared for by doctors and nurses who provide highly specialised care 24 hours a day. In UK ICUs,...