After a stay in intensive care—especially following a very serious illness—there may still be a long road ahead. Leaving the ICU is often a major and emotional milestone. Patients and those close to them may feel joy, but also anxiety about leaving the close monitoring and familiar staff of intensive care. Most patients then move through several stages before returning to their usual life.
Leaving intensive care is good news. It marks the beginning of the next stage and of life after critical illness. Even so, it can be an anxious time for patients and families. They are leaving a setting they have gradually become familiar with and a team with whom they have shared intense experiences and may have developed strong bonds of trust.
The anxiety caused by moving from intensive care to another ward is known as “relocation stress”. It can be linked to the unfamiliar environment, less continuous technological monitoring and a lower staff-to-patient ratio. Improving means that you no longer need a healthcare professional close by at all times. In French ICUs, one nurse generally cares for two or three patients, whereas high-dependency and general wards have fewer staff per patient. This change can be difficult to adjust to.
This is also often when patients begin to realise how vulnerable they have been and how much recovery still lies ahead. Family and friends can play a very important role by providing support and reassurance and helping the patient gradually rebuild confidence.
Be assured that the intensive care team will only arrange a transfer once they are satisfied that the patient no longer needs ICU-level monitoring and treatment.
Dr Arifoglio’s perspectiveLeaving the ICU and relocation stress
Depending on their needs, a patient may go through some or all of the following stages after leaving intensive care. Every care pathway is personalised and adapted to the individual patient.
In France, post-ICU rehabilitation units—known as services de réadaptation post-réanimation (SRPR)—specialise in caring for patients who continue to have respiratory and/or neurological failure after their other organ problems have stabilised or recovered.
They are intended for patients who still require highly specialised care usually provided in intensive care, such as complex weaning from mechanical ventilation, ventilation through a tracheostomy, or support during recovery from a prolonged coma when technical care and close monitoring are still needed.
SRPR units work closely with an ICU or other critical care service. They provide personalised rehabilitation alongside the medical, technical and monitoring support required by each patient.
A stay in an SRPR can be demanding. Depending on their needs, patients may have frequent sessions with physiotherapists, neuropsychologists, occupational therapists, speech and language therapists and other rehabilitation professionals. The aim is to help them regain as much independence and normality as possible, as soon as possible.
Depending on the condition that led to intensive care, patients are often transferred to a specialist ward such as cardiology, respiratory medicine or neurology. The level of monitoring may decrease gradually, with a period in a high-dependency or intermediate care unit before transfer to a standard ward.
A specialist ward provides a bridge between intensive care and follow-up in the community. The team can fully assess the affected organ, change intravenous medicines to oral treatments, gradually remove equipment that is no longer needed and plan medium-term follow-up.
This is a good opportunity to review your treatments and the longer-term management of any organ-related after-effects with the specialist. Ask any questions you have.
In France, follow-up and rehabilitation facilities—traditionally known as soins de suite et de réadaptation (SSR)—specialise in rehabilitation and helping people regain independence. After a long stay in intensive care, it is common to spend several weeks or sometimes months in such a centre before being ready to return home.
As in an SRPR, recovery is the main focus. The stay is not necessarily restful: each day may include physiotherapy, occupational therapy, speech and language therapy and other forms of rehabilitation designed to help you return as quickly as possible to the most independent and fulfilling life you can.
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This is another major milestone in your recovery—probably one you have been working towards and eagerly awaiting.
Before leaving hospital, you should receive:
Returning home can feel both rewarding and frustrating. The joy of being back in familiar surroundings and the peace of your own home may be accompanied by anxiety about having less monitoring and support than in hospital. You may also become more aware of the independence you have not yet fully regained. Try to be patient and kind to yourself. At this stage, focus on small, realistic goals: a few more steps each day, a short trip outside, and enough rest to make progress safely.
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Do not expect too much of yourself. Recognise and respect your limits, and take care. After intensive care, it can take months to regain your strength, become fully independent and return to your previous activities. Your body needs time to repair and recover from what it has been through. Understanding the seriousness of your illness may make this time easier to accept. If it feels helpful, ask your family what happened during your ICU stay. You can also return to the unit and talk to the professionals who cared for you. They will often be pleased to see your progress and may help you make sense of your experience. Meeting them can also help you recognise how far you have already come.
Some intensive care units offer follow-up after discharge. These services are still relatively new and are not yet available in every hospital. A post-ICU appointment helps bridge the gap between intensive care and the period that follows. Depending on the hospital, it may include a broad or targeted assessment by a doctor, nurse, physiotherapist and/or psychologist. It is a good place to ask questions about your stay, discuss how you experienced intensive care, or request to see an ICU room or meet members of the team again.
Raise anything that concerns you. This includes “minor” symptoms that teams may not ask about directly but that can still be uncomfortable, disabling or distressing—and therefore may otherwise go unrecognised and untreated. You can also discuss your emotional wellbeing, changes in family life, support you may need, returning to work, and rebuilding confidence in your body through movement or sport.
These appointments are equally valuable for healthcare professionals. They help teams understand patients’ experiences and the longer-term effects of intensive care, identify new needs and improve care. The more openly patients share their experiences, the better care can become both during and after intensive care. Do not hold back.
After leaving intensive care, you may need frequent medical appointments at first, depending on your health. These will usually become less frequent over time. They provide an opportunity to review your progress and discuss any difficulties you are experiencing.
Ask all the questions you need to and mention every symptom, even if it seems minor. This can help you regain a sense of control over your health and daily life. The team may also refer you to professionals experienced in supporting people after intensive care, such as physiotherapists, psychologists or psychiatrists.
Your GP can be a key partner throughout your recovery.
After a long stay in intensive care, returning immediately to full-time work is uncommon. A period of transition and adjustment is often needed, depending on the cause of your illness, any ongoing effects and the nature of your job. Listen to your body, respect your limits and allow yourself the time needed to recover; pushing too hard too soon can be counterproductive. Discuss the return with your GP and seek advice from social-care or occupational-health professionals if needed. In larger organisations, human resources may be able to arrange temporary adjustments or a phased return.
For some people, intensive care is a life-changing experience that alters their priorities and prompts them to reconsider their career. Listen to what matters to you, but give yourself time to think and seek support with any new plan. Avoid overestimating your energy and protect your recovery.
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