Differences between tele and stepdown

My tele unit pulls the lines after heart caths. Our main patient population is Pre/post heart caths and stents, pre/post CABG's, pacemaker insertions, and thoracotomies. Obviously all of the cardiac drips and titrating them as well. Also, all the heart related stuff like CHF, abnormal heart rhythms, etc. Does this help?

In tele at my hospital, the tele techs monitor patients' heart rhythms. In stepdown, the EKG is on your monitor for you to monitor. You generally have a 1:3 ratio in stepdown, lower than in tele. Most of the patients are transfers from the ICU and stay a while before transfer to the floors.

A stepdown patient can have an arterial line, a diltiazem drip, and (rarely )be a chronic ventilator patient.

In my hospital, I work on a telemetry unit. The majority of our pts are chest pain, chf, htn, etc. We have a cath lab that does the cardiac caths +/- interventions. If the pt needs a STENT, they usually go to ICU or PCU for 24 hours after. If no intervention needed, they come directly to us, but we get them after the cath lab nurses have pulled their sheaths and the pt is hemodynamically stable. Lots of times, we get ED admits to our unit that will have procedures the following day (stress tests, caths, etc.). The results of those tests determine whether they come back to us or are sent to a higher acuity unit. Some of our pts get cathed and are sent directly to the major heart hospital if the results show they need a CABG, since we do not do those at our hospital.

A stepdown unit deals with all medical and cardiac issues that are not quite critical enough for ICU, but not stable enough for a tele or medical unit. They do have pts on vents sometimes, but they are usually pts who are not critical except for being chronic vent pt.

Does this help?

Amy

It really depends on what each particular hospital designates each one as. I've been on tele floors that pulled sheaths, titrated gtts, took vents, and did all the things a stepdown unit did at a different hospital. I've been on stepdown units that had basic tele pts with hardly any gtts, or even cardiac monitors, but the pts were too heavy for the floor because of frequent vs/neuro checks, or being physically demanding, but they weren't unstable enough for ICU. It all really depends on where you are at and what the hospital policy is. The one thing that I've found consistent is that you usually don't have 5-7 pts when you are on stepdown or "IMC" like you might get on tele. Used to only get 4 pts on tele but that seems to have changed in the places I've been recently.