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Hospital wards

Recovery from critical illness is a journey that begin in the intensive care unit (ICU) and in most cases patients will go to the hospital ward before getting home.

The journey can vary depending on the levels of care needed and sometimes specialist input may be required to support recovery and rehabilitation. Many patients will go to one of the high dependancy units (HDUs) before getting to the hospital ward.

Moving from the Intensive care unit (ICU) to the High dependency unit (HDU)

Most patients (around 80%) will recover from critical illness and the improvement in their condition will be monitored continually by the ICU doctors, nurses and other members of the ICU team. When you no longer require your breathing to be supported by a mechanical ventilator (breathing machine), the ICU doctor will consider moving you to the high dependency area (HDU) at St Thomas's, which is on the 10th floor in the East wing of the hospital. If you are cared for at Guy's, on the Guy's critical care unit (GCCU), you will remain in GCCU until you are ready to step down to the ward. There is no HDU at Guy's so this care is given on GCCU. 

HDU at St Thomas's hospital

While in the HDU at St Thomas' Hospital, less intensive care and further recovery is needed before being ready to step down to the ward. The main factor affecting whether you need to stay on the HDU is the amount of nursing care and input from other members of the specialist clinical team e.g. physiotherapist.

Transfer from Guy's and St Thomas' ICUs to your local ICU or HDU

Many patients live in Kent, Surrey and Sussex and come to Guy's and St Thomas' Hospital for specialist treatment, (ECMO, major heart and vascular surgery) when there is no longer a need for this specialist input, but more time and support in ICU/HDU is required, then transfer to your local hospital will be planned. The transfer from the ICU at Guy's or St Thomas's to the local ICU is planned based on which hospital you originally came from or where your local hospital with the necessary specialist doctors for your ongoing care are are based.  

Medical conditions requiring specialist centres

Some conditions require specialist rehabilitation and these include:

  • injuries to the brain
  • stroke
  • limb amputation
  • long term breathing difficulties that require support from a ventilator (breathing machine).

Brain injuries require specialist input in neuro-rehabilitation centres and transfer to these highly specialised centres requires the neurology, stroke, occupational therapy, physiotherapy team to plan and liaise with the regional units

Stroke rehabilitation occurs on Mark ward at Guy's and St Thomas'.

Long term breathing conditions requiring mechanical ventilation are cared for on the Lane Fox Unit (LFU) located in the South wing of the hospital on the ground floor. The LFU supports the REMEO unit in Redhill, Surrey where some patients with long-term breathing conditions are transferred for ongoing care. 

Major Limb amputation is mostly performed at St Thomas' Hospital. Shortly after amputation, when you are medically well and if ready to complete an intensive amputee rehabilitation programme, we will transfer you to our specialist Amputee Rehabilitation Unit where you will participate in therapy every day. The unit has 12 beds and is located at Lambeth Community Care Centre in Kennington, London. 

Getting to the hospital ward

This can be a real mixed bag of emotions for patients and families. While ward transfer is a sign of improvement and a step closer to going home, patients and families have to adjust to less monitoring and having fewer staff at close hand. 

For some people, it is only once they come to the ward, and “body and mind” are working a little better, that they feel ready to start trying to make sense of what they remember happening while in ICU. Some people don’t remember their time in ICU at all, some remember it in brief flashes, some remember things very vividly – all of which can be scary and confusing.

In this section, we've provided some general information and advice on common physical and psychological issues during the ward stage of recovery, the types of staff involved in your care (who they are and what they do) and what to expect in terms of planning your home.

 

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External Video: Frightening dreams and hallucinations in ICU: a video by the Faculty of Intensive Care Medicine (FICM)

Unfortunately many patients experience hallucinations, such as seeing things that aren’t there, whilst on critical care. Almost two thirds of the patients we see in the post ICU recovery clinic admit to having experienced them. They can be very frightening and bizarre. Patients frequently report feeling that they were trapped or being held captive. Some people even felt that the staff were trying to harm or even kill them. This video is 7 minutes 47 seconds long with patients talking...

Document: GSTT memory impairment information leaflet

This post ICU information Sheet was developed by Dr Mary Summers and Dr Noelle Blake, both are Consultant Clinical Neuropsychologists, at the Maudsley Hospital part of South London and Maudsley NHS Foundation Trust, Neuropsychology and Neuropsychiatry Service. It explains the memory difficulties that patients have after critical illness and offers some strategies for managing these problems. There are links to other website that focus on memory services to support patients, relatives and...

Web Link: Hospital discharge planning-what to expect

Patients should be fully involved in planning for going home and should be kept informed of any changes. Each hospital has its own policy and arrangements for discharging patients. Nevertheless, there are often standards of care and information that must be met for patients and their family members. Going gome from hospital can, and often does, involve a number of different health and social care professionals, and it’s a good idea to know who is involved in arranging your discharge...

Article: I don't remember what happened to me on ICU: patient quotes

It’s extremely common for patients to remember very little of their time in Intensive Care. Sometimes patients “lose” the few days prior to ending up in Intensive Care and may struggle to make sense of how they ended up there. “The last thing I remember was…the ambulance. I don’t remember anything else until I woke up weeks later.” “It felt very strange…because I really wasn't sure whether I was ill, whether I'd had an...

Article: Post ICU recovery services

What is Intensive Care follow up? Follow up basically involves Intensive Care staff seeing patients after they've been transferred to the general wards or at an outpatient clinic after they've gone home. Follow up is also sometimes known as "outreach". Do all Intensive Care Units follow up their patients? No. Some Intensive Care Units have staff who see patients after Intensive Care and some don't. Who is involved in follow up? Some services are led by an...

Document: Incontinence patient guide - American Urological Association

This document has excellent information about urinary incontinence and will be helpful to better understand the problem. Please use this document and also the nhs website (link below) to plan how to manage: Urinary incontinence NHS website

Article: Joint stiffness and pain

Patients sometimes suffer from stiff and painful joints after Intensive Care, particularly in the ankles, knees, elbows and shoulders. This can make it difficult to do simple things like getting out of bed, walking around the ward or washing and showering. Why do I have joint stiffness or pain? Patients who have spent longer in Intensive Care seem to be at greater risk of developing joint stiffness and pain. Joint stiffness and pain can be due to several things but is most likely a...

Article: Mobility issues (walking)

Once you are transferred to the general ward and are beginning to become more active, you may be surprised to notice that you are perhaps not quite as able to do the things you thought you would. There are a number of reasons for this, not least that you are still in the very early stages of recovering from a serious illness, an operation or an accident. Tiredness and general weakness are extremely common, even if you only spent a short time in Intensive Care or were previously fit and...

Article: Muscle wasting and weakness

Why do you get muscle wasting? In the early stages of your illness, you may have been unconscious, and needed help from a breathing machine (or ventilator) for your breathing. During this time, you will have been unable to use the muscles in your arms and legs, and to move your joints yourself. We know from research (where pictures have been taken of the patients' muscles) that these muscles reduce in size, or waste, when they are not being used. This can happen quite early in...

Article: Not remembering what happened to you

Once patients are transferred to the wards, they often "come to" and have to begin to make sense of what's happened to them. Not remembering (amnesia) how you ended up in Intensive Care and what happened while you were there is extremely common. Patients sometimes "lose" the few days before ending up in Intensive Care, even though they were comparatively well at that time. Not remembering is likely to be a combination of how ill you were, the nature of your illness,...

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