Telemetry vs. Step-Down

[BlueShoes12, BSN, RN]

In your opinion, what constitutes a telemetry unit and what constitutes a step-down unit?

I'm curious about what your personal experiences are in differing levels of care provided by a telemetry vs. a stepdown unit. In my experience, the definition and expectations vary widely from hospital to hospital.

I work on a unit that the hospital used to call stepdown/respiratory monitoring but now calls telemetry. The ratio is 3-1 for day and night shift. We care for post-surgical, trauma, medical, neuro and the occasional cardiac patient. We care for patients on BiPAP and on titratable cardiac drips such as Cardizem, amiodarone, nicardepine and nitroglycerin. Insulin drips are very unusual but acceptable. Vital signs are q4 hours unless actively titrating medications. All patients are on telemetry, which the nurses are responsible for monitoring. We do not care for patients on any pressers or on vents.

Thanks in advance for your feedback!

[MunoRN, RN]

Telemetry often refers to a progressive care unit, which can describe a step-down unit. It's never made much sense to use the term "telemetry" to describe a level of care or acuity. Telemetry just means some sort of monitoring is in use, telemetry is used in outpatient settings, observation units, procedural care settings, surgical floors, medical floors, progressive care, step-down, ER, and critical care, so it serves no real purpose in defining what a particular unit is.

A 3-1 ratio typically describes step-down, which can include BiPAP dependent, titrated drips other than pressors, day 1 open hearts, stable vents, nurse-monitored telemetry, and generally patients who might need to become full-ICU patients but not yet, or full-ICU patients that are ready to begin transitioning to a regular floor but aren't quite there yet.