What's the difference between a LTACH and IMCU?

[withersp]

I work at a LTACH but BMC has an application out for the IMCU. I don't see the huge difference between the two. But IMCU sounds like I'd be better able to get my foot in the door to an ICU in the near future.

[Here.I.Stand, BSN, RN]

IMCU is intermediate/stepdown, correct? The big difference based on my observation is LTACHs take patients who are still on the ventilator, and SD does not. LTACH patients also tend to be more medically complex due to the length of their infirmity (google "chronic critical illness") My current ICU sends many patients to the LTACH I used to work in, because they had become stable enough that they don't need a high-level ICU anymore, but still on the ventilator so unable to go to our SD units.

Both units have patients sicker/more acute than floor patients and both heavily utilize tele.

The downside of LTACH for transitioning to ICU is that unless the unit transfers people to LTACH regularly, the manager may not have a good understanding of what it is. I had actually never even heard of LTACH until I was job hunting and found postings for the one I used to work at. I had heard the name of a larger local LTACH but always thought it was subacute rehab. Heck if you check out the LTACH forum here on AN, a good number of the questions are about long term care, as in nursing homes.

The downside of LTACH, period -- again at least in my experience -- are the ratios. ICU ratio is 3:1 which can be doable...floor ratio is 4-5:1 which can be hell. Also in a freestanding facility, when someone codes the floor staff IS the code team. That's intimidating. Families tend to be more on edge than anywhere else I've worked, again because their loved one had been through the ringer already in the weeks-months since becoming ill or hurt.

I personally felt like it was excellent prep for getting back into the ICU after years away, and had easier shifts during the times I've floated to our stepdown units which have a max ratio of 3:1. Not that anyone sits around eating bonbons working stepdown, but LTACH is a different animal.

[Here.I.Stand, BSN, RN]

Sorry I missed the part where you said you work at an LTACH now, so much of that probably isn't news to you.

[HouTx, BSN, MSN, EdD]

Honestly? LTACHs are primarily differentiated by the payment/reimbursement structures.... these are patients that (years ago) probably would have remained in an acute step-down unit for eons but with changes and limitations on acute care reimbursement, this became a huge drain on the hospital bottom line. So, we now move them out to an LTACH rather than keeping them in acute care. I have a dear friend -LTACH CNO- who calls hospitals "S(hort)TACHS".

Another big difference that I have noticed in our LTACHS is the staffing mix. They employ LV/PNs who work with RNs in a team-based delivery model. Depending on the patient mix, they may have an RT that is also part of the team... handling all the ventilator & O2 stuff. Patient stays are much longer. Nurses get to know patient families much better so they have an opportunity to engage in a lot more pt/family teaching But other than that, it's pretty much the same stuff you'll find in acute care.