Hospital Intermediate Nursing Unit

Hospital Intermediate Nursing Unit (Step Down ICU)

According to Armony, Chan, and Zhu (2014), Step Down Units (SDU) are examples of intermediate care units that provides closer care to patients for the prevention of hospital admission or readmissions. These units provide specialized intermediate level care between Intensive Care Units (ICUs) and the usual hospital medical-surgical wards (Armony, Chan, & Zhu, 2014). Armony, Chan, and Zhu (2014) observe that the role of the SDU is to treat patients suffering from severe medical conditions as compared to the typical patients in wards. However, the patients treated in SDUs do not require intense or critical monitoring as the ICU patients. The SDUs help in taking care of the “sicker” patients while at the same time taking pressure off the intensive care units for better patient outcomes and increased care efficiency.

Armony, Chan, and Zhu (2014) hold that SDUs have a high probability of impacting on the medical or nursing specialties. The SDU increases the efficiency of the delivery of nursing care for sicker patients by enabling the hospital managers to determine the size of each unit in the hospital. This allows the managers to allocate optimal number of nurses to each unit. Chan, Green, Lu, and Escobar (n.d.) posit that SDUs impact positively on the medical community settings. In their explanations, Chan, Green, Lu, and Escobar (n.d.) holds that SDUs improve the outcomes of patient treatment in a number of ways. Firstly, the SDUs significantly reduces the hospital mortality rates. The most critical aspect is that the SDUs improve the provision of medical care, which reduces the rate of ICU readmission, thus saving health care costs. Furthermore, the SDUs reduce the patients’ stay in hospitals.

Annotated Bibliography

Amato-Vealey, E., Fountain, P., & Coppola, D. (2012). Perfecting patient flow in the surgical setting. Association of Operating Room Nurses. AORN Journal, 96(1), 46-57.

The authors observe that the primary cause of hospital grinding is the delayed transfer of patients from ICU and intermediate care units. The authors utilize six-sigma models to illustrate how hospitals can overcome the delays. The article concludes by observing that implementing the six sigma project in the transfers of patients sustains a seamless surgical flow of patients from the ICU to the intermediate care units without requiring extra budgets.

Armony, M., C. W. Chan, B. Zhu. 2013. Critical care in hospitals: When to introduce a step unit? Working Paper, Columbia Business School.

The article examines the tradeoff of reserving additional capacity for critically ill patients in the SDUs and the intensive care units as a result of lower staff nurses requirements. The authors posit that under some circumstances, having a sizeable SDU has nursing and medical benefits. The article presents useful information that can help hospital managers to allocate nurses in different hospital units in order to allow SDU realize positive patient outcomes by relieving the ICU.

Capuzzo, M., Volta, C. A., Tassinati, T., Moreno, R. P., Valentin, A., Guidet, B., … & Rhodes, A. (2014). Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study. Critical Care, 18(5), 1-15.

Capuzzo et al. (2014) conducted a study to examine if adults admitted to health care institutions with both Intermediate Care Units (IMCU) and Intensive care Units (ICU) exhibited lower rates of in-hospital mortality compared to those admitted to ICU that did not have IMCUs. The authors observed that out of the 5834 patients enrolled, 19.1% (1113) succumbed to death in the ICU and 23.9% (1397) passed away in the hospital. This indicates that there was a higher severity in institutions that had an IMCU in the ICU ((SAPS) Simplified Acute Physiology Score 11:37) in comparison to ICUs without (SAPS11:29). This indicates that the presence of an IMCU in a health institution is associated with significantly decreased rates of mortality in adult patients admitted to the ICU.

Chan, C. W., Green, L. V., Lu, L., & Escobar, G. (n.d). The Role of a Step-Down Unit in Improving Patient Outcomes. Retrieved from <http://www.columbia.edu/~cc3179/sdu_routing_2014.pdf>.

The article explores the role of intermediate care, an SDU, with an aim of elucidating its impact on the treatment of semi-critically ill patients. More specifically, Chan, Green, Lu and Escobar concentrated on examining the role of SDUs between intensive care units and hospital medical wards on two important aspects: patient outcome; and patient flow. The authors report that SDU significantly reduce the hospital mortality rate, reduce the rate of patient readmission, and shortens the length of hospital stays.

Eichenberger, A. S., Haller, G., Cheseaux, N., Lechappe, V., Garnerin, P., & Walder, B. (2011). A clinical pathway in a post-anaesthesia care unit to reduce length of stay, mortality and unplanned intensive care unit admission. European Journal of Anaesthesiology (EJA), 28(12), 859-866.

Eichenberger, Haller, Cheseaux, Lechappe, Garnerin, and Walder (2011) carried out a study to assess the effect of a clinical pathway administered in a post-anesthesia care unit with regard to the post-operative outcomes. The study revealed that the patients’ characteristic remained the same before and after the administration of the clinical pathway, but variations were observed when patients went through more high-risk interventions and elective procedures. The study concluded that a clinical pathway employed in a post-anesthesia care unit has the capacity to remarkably decrease the duration of the patient’s stay and can also enhance post-operative outcomes.

Eid, R. C., Domingues, F., Barreto, J. K. S., Marra, A. R., Silva, C. V., Paes, Â. T., … & Edmond, M. B. (2011). Successful prevention of tracheostomy associated pneumonia in step-down units. American Journal of Infection Control, 39(6), 500-505.

The authors investigated the role of SDUs in the prevention of health-care-associated infections in the intensive care setting. Specifically, the article presents the treatment of patients with pneumonia associated tracheostomy, which involved preventive measures in SDU in different periods on the ventilation device. The results of the study indicate that SDUs have the potential of improving the prevention of tracheostomy through the creation of multidisciplinary monitoring of treatment regimes in the SDUs.

Kostopanagiotou, G., Kalimeris, K., Pandazi, A., Salamalekis, G., Chrelias, C., & Matsota, P. (2011). The role of the post-anaesthesia care unit in the management of high-risk obstetric patients. Archives Medical Science, 7(1), 123-126.

The authors describe the efficiency of using a post-anesthesia care unit in the treatment of high-risk obstetric patients after a postpartum operation. A post-anesthesia intermediate care unit reduces unnecessary readmission of high-risk patients to the ICU. The authors indicate that proper management of patients in intermediate care units increases efficiency, which reduces health costs and improve patient outcomes.

Millar, A. N., Hughes, C. M., Passmore, A. P., & Ryan, C. (2014). Intermediate care: The role of medicines management. Drugs & Aging, 31(1), 21-31.

The authors present a succinct review of the literature on the existing gaps in medication management for intermediate care of older patients, who are increasingly affected by polypharmacy, age-related changes, and inappropriate prescribing. They explore the importance of pharmaceutical involvement in the core services provided in intermediate care units. The authors posit that a multidisciplinary involvement, especially the collaboration with pharmacists improves patient outcomes by reducing the risk of discontinuity of care.

Probst, S., Cech, C., Haentschel, D., Scholz, M., & Ender, J. (2014). A specialized post anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial. Critical Care, 18(4), 468.

According to Probst, Cech, Haentschel, Scholz & Ender (2014) conducted a study to investigate whether a specialized Post-Aesthetic Care Unit (PACU) could enhance the fast-track management during cardiac surgical interventions. In this regard, the efficacy of the PACU was compared to the intensive care unit (ICU). The study revealed that the average extubation duration was 90[50; 140] min within the PACU in comparison to 478[305; 643] within the ICU group. This indicates that the therapy offered in a specialized PACU in comparison to that provided in the ICU during elective cardiac surgical procedure results in earlier extubation, as well as a fast discharge to a step down unit without compromising the safety of the patient.

Solberg, B. C. J., Dirksen, C. D., Nieman, F. H. M., van Merode, G., Ramsay, G., Roekaerts, P., & Poeze, M. (2014). Introducing an integrated intermediate care unit improves ICU utilization: A prospective intervention study. BMC Anesthesiology, 14(76), doi:http://dx.doi.org/10.1186/1471-2253-14-76

The article explains how a hospital can optimize bed utilization as well as improve patient access to the intensive care. The authors observe that the integration of the intermediate care unit in ICU has a great potential of improving the utilization of the intensive care. The article concludes by noting that intermediate care reduces the inappropriate use of the ICU and general ward beds, thereby optimizing the efficiency of facilities and the mean nursing workload.

References

Amato-Vealey, E., Fountain, P., & Coppola, D. (2012). Perfecting patient flow in the surgical setting. Association of Operating Room Nurses. AORN Journal, 96(1), 46-57.

Armony, M., C. W. Chan, B. Zhu. 2013. Critical care in hospitals: When to introduce a step unit? Working Paper, Columbia Business School.

Chan, C. W., Green, L. V., Lu, L., & Escobar, G. (n.d). The Role of a Step-Down Unit in Improving Patient Outcomes. Retrieved from <http://www.columbia.edu/~cc3179/sdu_routing_2014.pdf>.

Millar, A. N., Hughes, C. M., Passmore, A. P., & Ryan, C. (2014). Intermediate care: The role of medicines management. Drugs & Aging, 31(1), 21-31.