Next steps after the ICU

Leaving the ICU

The aim of the ICU is to support patients until the cause of their illness can be treated and resolved. For example, if you have pneumonia you may require intubation and mechanical ventilation to support your breathing until the infection can be cured by treatment with antibiotics. Some patients have very brief ICU stays of only 1-2 days. They are often previously healthy people who are recovering from scheduled surgery or have an easily treatable infection.

Longer or more complicated ICU stays happen for a number of reasons. These include entering the ICU with chronic serious illness, such as cancer, dementia, or heart, lung, or liver disease. Additionally, patients may require longer ICU stays if they have had a severe trauma or brain injury. Some people develop problems with their lungs and other organs as a result of powerful infections. Rarely, patients may get very sick after a surgery.

It is difficult to predict exactly when a patient may be well enough to graduate from intensive care. “What needs to happen so that I can leave the ICU” is a good question to ask your healthcare team.

Transitioning to Other Units

Patients are transferred out of the ICU only when the care team feels it is safe to do so. Patients will leave the ICU when they have recovered to the point where they do not need intensive monitoring, and when they are no longer requiring any treatments that can only be given in an intensive care unit. After the ICU, patients usually will stay at least a few more days in the hospital before they can be discharged. Most patients are transferred to what is called a step-down unit, where they are still very closely monitored before being transferred to a regular hospital floor and then hopefully home.

This can be an anxious time for ICU patients and families, who are used to the constant attention they received in the intensive care unit. The nurses and other providers in the new unit want to hear these questions and concerns. They count on patients to let them know immediately if they start feeling worse.

A case manager will work closely with a patient and his or her care team to ensure a safe transition from within the hospital to the right next environment, whether that is home, an acute rehabilitation facility, or a skilled nursing facility. Some people will not need any additional services and can simply follow up with their regular doctors in the office. Many patients, especially those who have been in the ICU for a long time, will require skilled help. The case manager and the patient’s team, together with physical and occupational therapists, will determine what is right for the patient. Some people are discharged to an acute rehabilitation or skilled nursing facility for additional treatments and physical therapy. Others are able to have nurses and therapists visit their home. You will participate in making the plan and will know what it is before you leave the hospital.