Difference b/w TCU/Stepdown and ICU/Stepdown?

RN1989 · Jul 24, 2008

Really depends on the facility's definition.

A stepdown unit is generally between ICU and tele. They are monitored, have stable vents, patients with lots of tubes, etc. They usually have staffing that is 1:3-4.

I have seen TCU (transitional care unit) that is a stepdown as I've described. At other places the TCU was more of a high acuity nursing home/skilled nursing type unit.

If you are looking at a job, ask to see things their admission criteria to get a better feel for exactly what they are calling stepdown or TCU. Sometimes they will call it one thing when it really isn't.

ncnurse99 · Jul 25, 2008

Sorry to seem ignorant, but the TCU stepdown I am familiar with is Trauma Care Unit Stepdown. These patients are still not in best of shape, some w vents, trachs and lots w telemetry. They crash frequently. What is the TCU u are referring to?

RN1989 · Jul 25, 2008

The TCU notation that I have come across is Transitional Care Unit. Which goes to show that facilities use different terms to mean different things.

ilstu99 · Jul 25, 2008

Both of our adult ICU units are always 1:1. The RN's there do total patient care, with assistance from RT and sometimes PT/OT. Any patient who is intubated stays in ICU and the patients there usually have multi-system problems. The assessments for our hospital are documented hourly, and status changes are frequent.

TCU and SD are anywhere from 1:1 to 1:3 (usually 1:2). Patients in those units might be "stable" (ha, ha) but still requiring a considerable amount of monitoring or hands-on care/assistance. They aren't an appropriate assignment, for whatever reason, to a post-op, surgical or tele unit where our ratio is typically 1:4 or 1:5. The TCU/SD RN's still do the majority of the patient care, but can and do delegate some things to HCT's such as a standby assist, feeding or bathing. The care is still complicated, and usually involves more than one body system (neuro/cardiac or cardiac/pulmonary, for example). The assessments are usually less frequent...say every 2-4 hours.

When they are progressing as well as can be expected, and

require even less frequent hands-on care and assessments (usually Q6 or less), they are shipped out to another floor like tele, surgical, rehab, etc.

Hope that helps. Understand, though, that every facility is different, and their unit designations can be completely different.