1. Home
  2. Jobs
  3. Step Down Unit Jobs

Step Down Unit Jobs

Step Down Unit

Stepdown beds provide a level of intermediate care between that of the general ward and intensive care units. They can be applied in stand-alone units or incorporated into standard wards. They are used in three ways. First, they are used to provide a higher level of care for patients deteriorating on a ward (“step-up”). Second, they are used as a lower level of care for patients transitioning out of the intensive care unit (“step down”). Finally, they can be used to receive postoperative patients who are recovering from surgical operations in recovery rooms until they are transferred to standard wards (lateral transfer of care). These units hold potential benefits yet their potential benefits remain primarily theoretical as few patient-level studies provide concrete evidence.

The healthcare system has improved during the last century, contributing to longer life expectancy in developed countries. Although the demand and cost of healthcare delivery have risen dramatically, intensive care provision contributes to these costs: From 2000 to 2005 in the United States, the number of critical care beds increased more than 6.5%, and critical care spending is now estimated to account for almost 1% of the Gross Domestic Product. The increasing availability of intensive care unit (ICU) beds is costly, but the alternative option of foregoing this expansion raises the concern of potential delays in admission from wards and emergency departments (EDs) and in elective surgery. In 2005, The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) approved a new standard calling on U.S. hospital leadership to implement plans that identify and mitigate barriers to efficient patient flow across the continuum of care.

Frequently Asked Questions

What kind of patients are on a step down unit?
A patient who has permanently recovered and is ready for discharge will not require intensive care. He or she may be defined as stepdown by exclusion, according to whether he or she requires frequent monitoring and/or nursing care, but has no organ support requirement. This level of care may be provided to patients who are critically ill; they rarely transition directly from intensive care to ward-level care.

The second group of patients is admitted to the SDU from an ED or hospital ward with increased care requirements. Patients in this group almost always need noninvasive ventilatory support or acute renal replacement therapy. Hilton and colleagues found that 33% of SDU admissions were step-up patients (8% from ED, 25% from wards), and Lucena and colleagues found that almost 80% of SDU admissions were step-up patients (25% from ED, 52% from general wards), suggesting that this group of patients represents a substantial part of the individuals cared for in SDUs.

The third category involves a small proportion of potential SUDU admission patients: those who are admitted either directly from the operating room or after a short period of observation in a recovery room. These patients have three characteristics: (1) underlying comorbidities, (2) effects of surgical and anesthetic interventions in the operating room, and (3) postoperative nursing or other care needs. Some SDUs may be designed explicitly for the admission of postoperative patients, whereas others admit medical and surgical patients. After the development of a mixed medical-surgical SDU at a single center, Hilton and colleagues found that 16% of admissions were postoperative patients.

Is a step down unit considered critical care?
In hospitals, Step Down Units provide an intermediate level of care between Intensive Care Units and general medical-surgical wards.

How long do patients stay in step down unit?
The average length of stay in the unit is usually between four and five days.

When to introduce a step down unit?
Healthcare settings often use Step Down Units (SDUs) to bridge the gap between patients who have recovered from an intensive care unit (ICU) stay and those who remain on a general ward. Because SDUs are less richly staffed than ICUs, they are less costly to operate; however, they also cannot provide the level of care required by the most critically ill patients. There is an ongoing debate in the medical community as to whether and how SDUs should be used. One school of thought favors using SDUs to alleviate ICU congestion by providing a safe environment for post-ICU patients before they are stable enough to be transferred to the general wards. On the other hand, an SDU can take capacity away from already over-congested ICUs. In this work, we propose a queueing model of patient flow through the ICU and SDU in order to determine when an SDU is needed and what size it should be.

RNs, CNAs, and LPNs connect to local facilities that are ready to fill nursing jobs immediately through the Nursa app.
Nurse Writing on wall

Download the Free App