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.

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.

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.

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.

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.

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.

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.

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.

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.

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