Differences between tele and stepdown

[rn undisclosed name]

Are there differences between these two? I thought they were one in the same but I have been looking at some classifieds for different positions and the stepdown unit deals with things I've never dealt with and would never deal with on tele.

For example, IABP and sheaths being pulled. Those are only dealt with in the ICU. The majority of patients we have in my tele unit are pretty stable. If they are becoming unstable they go to the ICU. I'm just curious how it is in other hospitals.

I just think you have too many patients in tele and with monitoring their heart rhythm and couldn't imagine sheaths or IABP. Just seems a little too much to me.

[purple_rose_3]

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?

[RNperdiem, RN]

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.

[al7139, ASN, RN]

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

[RN1989]

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.

[Daytonite, BSN, RN]

A unit is what the facility wants it to be. I've probably seen 10 different names for "telemetry" type units over the years. I worked in a hospital that had an ICU stepdown unit and a CCU stepdown unit. We were cross trained to work in the ICU and often got floated there when they had call offs or were short staffed. We often had patients with leftover hemodynamic lines, arterial lines, dopamine drips, chest tubes and ventilators.

My local hospital has a telemetry unit and they put patients from both ICU and CCU on this unit. However, I've found that they also have telemetry patients on just about every unit just being monitored. Nothing complicated with those patients except making sure their leads are on correctly and the monitors are being watched. I think heart monitoring is getting to be a safety issue with a lot of the docs wanting their patients with any kind of heart issue being monitored.

When you are looking at job ads it is best to contact the individual hospitals (or sometimes you can go to their websites if they have them) and ask for a description of what goes on in that unit. A name is just a name. As Shakespeare's Juliet Capulet said, "What's in a name? That which we call a rose by any other name would smell as sweet."