The role of stepdown beds in hospital care

Abstract

Stepdown beds provide an intermediate level of care for patients with requirements somewhere between that of the general ward and the intensive care unit. Models of care include incorporation of stepdown beds into intensive care units, stand-alone units, or incorporation of beds into standard wards. Stepdown beds may be used to provide a higher level of care for patients deteriorating on a ward ("step-up"), a lower level of care for patients transitioning out of intensive care ("stepdown") or a lateral transfer of care from a recovery room for postoperative patients. These units are one possible strategy to improve critical care cost-effectiveness and patient flow without compromising quality, but these potential benefits remain primarily theoretical as few patient-level studies provide concrete evidence. This narrative review provides a general overview of the theory of stepdown beds in the care of hospitalized patients and a summary of what is known about their impact on patient flow and outcomes and highlights areas for future research.

Keywords: continuity of patient care; critical care; intensive care unit; intermediate care.

Figure 1.

Schematic representation of potential stepdown unit (SDU) locations and the relation to nearby units. ICU = intensive care unit.

Figure 2.

Schematic representation of the effects of stepdown unit (SDU) location on nurse to patient ratios. Solid rectangles represent intensive care unit (ICU) beds; shaded rectangles represent SDU beds; open rectangles represent ward beds; triangles represent nursing staff (RN).