Leaving the ICU
Being discharged from the intensive care unit (ICU) is both an exciting and anxious time for the patient and their family.
For some, leaving the ICU usually means that the patient is well on their way to recovery from a serious illness. But for others, continuing treatment in ICU will not improve their condition, nor will it change their ultimate outcome. In such circumstances, the patient will be moved to a ward for palliative care, where the focus is on the patient’s comfort.
This page gives you an overview of the ICU discharge processes.
Who makes the decision to discharge a patient from the ICU?
The ICU team makes the decision about when a patient is ready for discharge to a ward. Terms such as ‘cleared for the ward’ or ‘booked out’ might be used.
The decision to discharge is usually made together with the patient’s primary care team, such as the surgeon or doctor who the patient was admitted under when they first came to the hospital. Generally, this decision is made on the morning ICU ward round, although some ICUs have rounds twice a day.
To which ward does the patient go?
This will depend on:
- the particular hospital
- what condition the patient has
- the patient’s ongoing treatment and care needs.
In larger hospitals, the patient will generally be moved to a speciality ward, whereas in smaller hospitals, it may be to the general wards.
If a patient came to the ICU after being transferred from a smaller hospital, then they might be transferred back to that smaller hospital. This will usually only happen if the smaller hospital can provide the ongoing care that’s needed, and there is a doctor able to look after the patient’s medical needs.
Who is responsible for the ongoing treatment of the patient discharged from the ICU?
When someone is admitted to hospital, they are admitted under a physician or surgeon who is given ongoing responsibility for the patient’s medical care. But when a patient is admitted to the ICU, this responsibility is negotiated between the ICU staff and the physician or surgeon.
When the ICU team is ready to discharge the patient to a ward, they contact the physician or surgeon the patient was admitted under, and discuss the patient's present condition and future treatment plans.
Once the patient is discharged to the ward or another hospital, it’s the admitting physician or surgeon who resumes the full responsibility.
Preparing to leave the ICU
Patients and relatives may notice a change in care as their loved one’s condition improves.
These changes usually involve:
- less monitoring and fewer interventions and treatments
- less nursing attention, as their nurse may have more than one patient to look after
- removal of medical devices, such as the arterial line and urinary catheter
- increased rehabilitation activities, such as walking, to improve movement.
When do patients leave the ICU?
Once the patient is cleared to discharge from the ICU, the ward manager is asked for a ward bed. The patient will be discharged once a ward bed becomes available. This usually happens on the same day, although it can take longer when the hospital is busy. Very occasionally, patients are cleared for discharge and are moved to the ward during the evening or at night.
These decisions are sometimes made because there are other critically ill patients who need an ICU bed. However, a patient will only be discharged from ICU if their condition has improved and the ward is able to provide the right care.
What happens when a patient leaves the ICU?
The medical and nursing staff complete paperwork to ensure a smooth move to the ward. Then the patient can be taken to the ward, where a handover is given to the ward’s nursing team. Also, the medical team who will be caring for the patient is contacted and provided with all the information they need.
What is an ICU liaison nurse?
Some hospitals have an ICU follow-up service, usually called ICU nurse liaison. This service was created to give continuous care during the changeover period. These nurses follow up the patient for several days.
If you have any concerns about a patient being discharged from the ICU to a ward or another hospital, please speak to the ICU team.