Concentrated Care Nightmare

Published

Up until last week I worked in a 12 bed ICU. We used to be 18 beds but 2 years ago they closed 6 beds because of a low census. Since then we do nothing but try and move people out because someone else needs a bed. Over the summer the senior managment informed us that those 6 beds would be reopend has a Concentrated Care (step down) unit and staff was hired. Right before Christmas and on the last week of the new staff's orientation we informed that there was a change in plan. The 6 beds would become a "clean" surgical ICU and the staff we had just hired would be given positions in other departments. Our origianl 12 beds would be broken up into 4 ICU bed, 4 concentrated care beds, and 4 beds that would start out closed and flex open depending on need. Also the ICU staff would be covering all the beds regardless of pt. type.

So last week the nightmare began. An ICU nurse is preassigned each shift to care for the concentrated care patients. Sometimes we have a PCA and we have one secrtary for both sides of our unit (when all the beds used to be ICU we had 2 secretaries). The MD's didn't know about this plan and were trying to figure out why their patients were in ICU. There we were trying to explain that they weren't. We labeled our central monitor with ICU and CC tags to no avail.

Then this week the hosptial census jumped and they opened the 4 closed beds with regular tele paients. So now we need ICU nurses to work overtime or nurses from other units are floated down to care for these patietns. We have different order sets for the different types of patients and since we're a teaching hospital our ICU residents are telling us they don't cover the other patients. It's such a mess.

My boss keeps telling us that these multi-level care units are the wave of the future. I have yet to find a journal article about them. (if you know of one please let me know). We have no computerized charting, or medication barcoding in our hospital. Every weekd they add a new form to meet Joint Comission recomedations. It's hard for us to chart less and we've decied you can't take the ICU out of the nures. We are having trouble managing our time and senior managment hasn't even come around to ask how its going and get any feedback. It's like we're invisable to them.

If anyone works in a functional multi-level care unit please let me know how it works. There aren't even enough of us to cover lunches right now. Thanks for listening to my rant.

Up Vote Up Vote ×
Up until last week I worked in a 12 bed ICU. We used to be 18 beds but 2 years ago they closed 6 beds because of a low census. Since then we do nothing but try and move people out because someone else needs a bed. Over the summer the senior managment informed us that those 6 beds would be reopend has a Concentrated Care (step down) unit and staff was hired. Right before Christmas and on the last week of the new staff's orientation we informed that there was a change in plan. The 6 beds would become a "clean" surgical ICU and the staff we had just hired would be given positions in other departments. Our origianl 12 beds would be broken up into 4 ICU bed, 4 concentrated care beds, and 4 beds that would start out closed and flex open depending on need. Also the ICU staff would be covering all the beds regardless of pt. type.

So last week the nightmare began. An ICU nurse is preassigned each shift to care for the concentrated care patients. Sometimes we have a PCA and we have one secrtary for both sides of our unit (when all the beds used to be ICU we had 2 secretaries). The MD's didn't know about this plan and were trying to figure out why their patients were in ICU. There we were trying to explain that they weren't. We labeled our central monitor with ICU and CC tags to no avail.

Then this week the hosptial census jumped and they opened the 4 closed beds with regular tele paients. So now we need ICU nurses to work overtime or nurses from other units are floated down to care for these patietns. We have different order sets for the different types of patients and since we're a teaching hospital our ICU residents are telling us they don't cover the other patients. It's such a mess.

My boss keeps telling us that these multi-level care units are the wave of the future. I have yet to find a journal article about them. (if you know of one please let me know). We have no computerized charting, or medication barcoding in our hospital. Every weekd they add a new form to meet Joint Comission recomedations. It's hard for us to chart less and we've decied you can't take the ICU out of the nures. We are having trouble managing our time and senior managment hasn't even come around to ask how its going and get any feedback. It's like we're invisable to them.

If anyone works in a functional multi-level care unit please let me know how it works. There aren't even enough of us to cover lunches right now. Thanks for listening to my rant.

They are the wave of the future, supposedly. The first one opened in 1999 at Clarian Health System's Methodist Hospital in Indiana (where the babies in the NICU were given adult-dosed heparin- same hospital). They promote continuity of care and save costs. I think I would hate working in one. Search for acuity-adaptable unit.

Up Vote Up Vote ×
Specializes in MICU/CICU/Currently CVR.

So you went from a 12 bed ICU that was consistently full to a 4 bed unit....how is this possible?

The only flexible acuity unit I have worked on was a CCU that had 8 critical care beds on one side of a LARGE unit and 6 "step-down" beds on the other side (6 empty rooms in between). Although the units were on the same floor, they were absolutely separate. CCU nurses staffed the CCU and step-down nurses staffed the STU.

I currently work in a 12 bed general ICU. Sometimes we have overflow from different floors (rare, rare, rare...). Overflow patients are a logistical nightmare! Our hospital is older so we only have bathrooms in 4 of the rooms. If your ambulatory tele overflow patient is in one of the rooms with no bathroom.... ugh...:uhoh3:!!! Also, trying to divvy up the workload between nurses is crazy! The last time this happened, I ended up with 2 critical patients (2 vents, one CVVHDF) and a tele patient (because they're not gonna be any trouble...the tele nurses take 6 at a time....)

Stuff like this just burns me up...:angryfire

Hang in there...

KC :specs:

Up Vote Up Vote ×
Specializes in SICU, EMS, Home Health, School Nursing.

I work in a department that consists of a 10 bed ICU and a 15 bed step-down unit. We have several nurses that are step-down only, but our ICU nurses work both areas. The two areas are right next to each other, but they are separated by a door and short hallway. We share the same clean utility room and dirty utility room. We will occasionally have step-down patients in the ICU if they are too busy for step-down (vent) or if there are no beds available on step-down. It works pretty well for us, but the majority of the ICU nurses hate working on the step-down unit.

Up Vote Up Vote ×
Specializes in MSICU, CCU.

We have a 24 bed ICU with a 6 bed tele,sometimes ICU side unit. If it is Tele, usually 2 nurses for 6 patients. Since our hospital dosen't have a a tele/vent unit, those patients make their way over there as well. So the extra teles or those waiting to get out of the ICU are in there and then they get assigned another bed later. No one seems to understand that patients in there are not always ICU, so thats a pain. Usually nurses will be assigned there for one day, then they want out. it is nicknamed the "hole"!

Up Vote Up Vote ×

I have not personally worked in a unit like that but a few local hospitals have started units similar to that, however it is a bit different. What they do is once a patient enters a room they don't leave until they are discharged. If they are a tele patient upon entering the hospital, and get transfered to ICU care the nurses change but not the room. To me it sounds confusing and really hard to do staffing, but once again I haven't worked there so I can't offer direct comments.

Up Vote Up Vote ×
Specializes in critical care.

Last year one of our 10 bed Units ended up closing 4 beds due to low census (we have 3 addl Units 10 beds each) anyhoo, once census increased...they opened those beds for TELEMETRY. We had to staff them too, so one nurse for 4 patients, no tech. Our CCP/PA's did not cover them so yes we had to call the attending for everything. Our order sets too did not apply, so yes it was a bit of a pain. The big problem came when one of those "tele" patients ended up getting into trouble, tho they were technically tele, we still had the equipment/knowledge base to care for them. One day I had the 4 tele patients, and a patient ended up crumping big time, needed emergent dialysis, couldn't keep BP up, started Levo, Dopamine, went into AFIB RVR, began Amiodarone, etc. agressively titrating drugs, began Resp Difficulties, etc. He stayed with me, while I had 3 other patients!!! I was incensed, ended up going to my manager, who fortunately does listen to us. She went to bat for us with the powers that be, and eventually it was phased out. Good luck with your dillemma. I do not think that Concentrated Care Units work too well yet. Perhaps in the future, but way too many staffing issues, etc need to be worked out.

Up Vote Up Vote ×

I actually attended a conference session once on something very similar: variable acuity patient rooms. It was a slightly larger private room that was wired the same way an ICU room was -- extra O2 and suction inlets, more electrical outlets, dimmable lights, and so on. All the rooms on that particular floor were like this, and they had computerized charting stations inbetween every 2 rooms, with windows into these rooms, just like an ICU. The theory behind it was that transferring a patient from the floor to the unit cost X amount of dollars, and you could potentially save about 800k a year by finding a way around these transfers, and then you could recover the expense of making these rooms bigger, with more hardware added too, in 2 or 3 years, I think. Good idea in theory, but I imagine that the staffing would be a serious drawback.

Up Vote Up Vote ×
Specializes in Not too many areas I haven't dipped into.
Up until last week I worked in a 12 bed ICU. We used to be 18 beds but 2 years ago they closed 6 beds because of a low census. Since then we do nothing but try and move people out because someone else needs a bed. Over the summer the senior managment informed us that those 6 beds would be reopend has a Concentrated Care (step down) unit and staff was hired. Right before Christmas and on the last week of the new staff's orientation we informed that there was a change in plan. The 6 beds would become a "clean" surgical ICU and the staff we had just hired would be given positions in other departments. Our origianl 12 beds would be broken up into 4 ICU bed, 4 concentrated care beds, and 4 beds that would start out closed and flex open depending on need. Also the ICU staff would be covering all the beds regardless of pt. type.

So last week the nightmare began. An ICU nurse is preassigned each shift to care for the concentrated care patients. Sometimes we have a PCA and we have one secrtary for both sides of our unit (when all the beds used to be ICU we had 2 secretaries). The MD's didn't know about this plan and were trying to figure out why their patients were in ICU. There we were trying to explain that they weren't. We labeled our central monitor with ICU and CC tags to no avail.

Then this week the hosptial census jumped and they opened the 4 closed beds with regular tele paients. So now we need ICU nurses to work overtime or nurses from other units are floated down to care for these patietns. We have different order sets for the different types of patients and since we're a teaching hospital our ICU residents are telling us they don't cover the other patients. It's such a mess.

My boss keeps telling us that these multi-level care units are the wave of the future. I have yet to find a journal article about them. (if you know of one please let me know). We have no computerized charting, or medication barcoding in our hospital. Every weekd they add a new form to meet Joint Comission recomedations. It's hard for us to chart less and we've decied you can't take the ICU out of the nures. We are having trouble managing our time and senior managment hasn't even come around to ask how its going and get any feedback. It's like we're invisable to them.

If anyone works in a functional multi-level care unit please let me know how it works. There aren't even enough of us to cover lunches right now. Thanks for listening to my rant.

Honey I am feeling your pain and frustration just by reading this. Overflow in the ICU is bad enough but this different level of care especially in a teaching hospital where the docs are already so delineated is a nightmare. OMG, I hope they find a solution to this for ya.

Any updates?

I have really never worked in a unit like that and I am now adding that to my list of things NOT to do.

Up Vote Up Vote ×
Specializes in CVICU, ICU, RRT, CVPACU.

We have 36, soon to be 48 ICU/CVICU/CCU beds and 6 Stepdown unit beds. Everyone is already mad about having to work in the step down. Our in house agency people are going to be assigned to it, so It shoudlnt be too bad for the ICU staff. That situation souds horrible though.

Up Vote Up Vote ×

Update:

Things have gotten a little better. We had a rush of ICU patients so we had a few weeks of only ICU patients. Now we only get the occasional non ICU pt. Of course with summer coming and being 2 blocks from the ocean who knows what lies ahead. The census house wide has plumeted in the last month with 2 units being closed for weeks at a time. So who knows what the future will bring. In the meantime I'm working on my grad school application because I don't think hospitals as we know them are long for this world.

Up Vote Up Vote ×
+ Join the Discussion