Discharging a Person from Intensive Care

Being discharged from the Intensive Care Unit (ICU) is both an exciting and anxious time for the person and their family.

For some, leaving ICU usually means that the person 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 person will be moved to a ward for palliative care, where the focus is on the person’s comfort.

This page gives you an overview of the ICU discharge processes.

Who makes the decision to discharge a person from ICU?

The ICU team makes the decision about when a person 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 person’s primary care team, such as the surgeon or doctor who the person 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 person go?

This will depend on:

  • the particular hospital
  • what condition the person has
  • the person’s ongoing treatment and care needs.

In larger hospitals, the person will generally be moved to a speciality ward, whereas in smaller hospitals, it may be to the general wards.

If somebody came to 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 that there is a doctor able to look after the person’s medical needs.

Who is responsible for the ongoing treatment of the person discharged from ICU?

When someone is admitted to hospital, they are admitted under a physician or surgeon who is given ongoing responsibility for the person’s medical care. But when a person is admitted to ICU, this responsibility is negotiated between the ICU staff and the physician/surgeon.

When the ICU team is ready to discharge the person to a ward, they contact the physician/surgeon the person was admitted under, and discuss the person’s present condition and future treatment plans.

Once the person is discharged to the ward or another hospital, it’s the admitting physician/surgeon who resumes the full responsibility.

Preparing to leave 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 person 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 people leave ICU?

Once the person is cleared to discharge ICU, the ward manager is asked for a ward bed. The person will then 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, people 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 people who need an ICU bed. However, a person 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 person leaves ICU?

The medical and nursing staff complete paperwork to ensure a smooth move to the ward. Then the person 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 person 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 person for several days.

If you have any concerns about a person being discharged from ICU to a ward or another hospital, please speak to the ICU team.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.