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.

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.

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.

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.

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.

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.

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.

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.

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.

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,...