Being Wardable: Patient, Family and Staff Member Views of the Otherness of Critical Care Survivors in a Ward Setting

AIMS: Discharge from an intensive care unit (ICU) to the ward has long been recognised as a difficult and dangerous time for patients. This study aims to explore the experiences of patients, family members and staff of ongoing care following discharge from ICU to the ward. DESIGN: An exploratory qualitative interview study, part of a mixed methods research project exploring post-ICU ward care to inform practice changes to improve outcomes for critical care survivors. METHODS: Semi-structured interviews were conducted with 55 purposively sampled patients, family members and multi-professional staff between 2017 and 2018 at three NHS trusts in the UK. Data were analysed thematically. FINDINGS: Three main themes were identified: Being wardable discusses the tension between perceptions of readiness for ICU between ICU and the ward staff; Post-ICU patients as other analyses the characterisation of otherness of post-ICU patients in comparison with other ward patients; and Fear and anxiety considers the impact of this perceived otherness on both patients and staff. CONCLUSION: The term wardable is used by staff to indicate the suitability or otherwise of patient transfer. There is a tension between being deemed wardable from an ICU and ward perspective. This exacerbates the perception of otherness and compounds the fear and anxiety related to post-ICU care experienced by both patients and ward staff. IMPLICATIONS FOR PATIENT CARE: By recognising the tension between being ready for ICU discharge (not requiring organ support) and being wardable (having care needs which can be fulfilled on the ward they are being discharged to), clinicians may better support patients during this transition of care. This has the potential to improve outcomes for post-ICU patients, as well as improve the experience by both patients and the staff and family members caring for them. REPORTING METHOD: The COREQ reporting checklist was used in the reporting of this manuscript. PATIENT AND PUBLIC CONTRIBUTION: Patients and public were involved throughout the REFLECT project, from design through to dissemination. This included advising on the approach to patient participants and supporting dissemination of results via social media. TRIAL REGISTRATION: ISRCTN: 14658054.