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.

The Impact of the Organization of High-Dependency Care on Acute Hospital Mortality and Patient Flow for Critically Ill Patients

“…The total duration of critical care (summing days in both the primary unit and the geographically separate unit, where relevant) was longer for patients cared for in primary units with dual HDC (median, 7 [4][5][6][7][8][9][10][11][12][13] vs. 6 [3][4][5][6][7][8][9][10][11] d; adjusted relative difference, 1.09 [1.03-1.16]; P = 0.002). Total acute hospital length of stay did not differ, nor did estimates of the overall costs of critical care, after risk-adjustment (Table 4).…”

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010

“…Since their initial description in the 1980s, intermediate care units (i.e., step-down, transitional, or progressive care) have offered an alternative model for delivering care to hospitalized patients-a less resource-intensive setting than the ICU that still provides a higher level of care than general hospital wards (2).…”

A Conceptual Framework for Improving Critical Care Patient Flow and Bed Use

“…Strategies to address capacity strain include unit expansion, revision of triage policies, and targeted efforts to reduce throughput delays (5-7). A step-down unit (SDU), or intermediate care-level unit, can relieve ICU congestion by caring for loweracuity patients in alternative settings (8)(9)(10)(11).…”