A progression in care at UCH

With the installation of a dozen telemetry units, all 36 beds on the Medical Surgical Progressive Care Unit can now be filled with progressive care patients, freeing up capacity in the ICUs.
January 24th, 2017
Tim Pratt, nurse manager on the Medical Surgical Progressive Care Unit, shows one of the recently installed telemetry monitors that now make progressive care available in all 36 rooms.
Tim Pratt, nurse manager on the Medical Surgical Progressive Care Unit, shows one of the recently installed telemetry monitors that now make progressive care available in all 36 rooms.

It’s not immediately apparent to the casual visitor, but an important change occurred Sept. 26 on the 10th floor of the Anschutz Inpatient Pavilion, home to the Medical/Surgical Progressive Care Unit. Call it “The Tale of the Teeter-Totter.”

No, it doesn’t involve the installation of playground equipment. Instead, all 36 patient rooms on the unit are now equipped with bedside telemetry units, essential for nurses to monitor vital signs and head off complications in patients. Until that time, 12 of the rooms lacked the monitors and were reserved for lower-acuity medical/surgical patients.

The conversion means that all 36 rooms can, if necessary, be taken by patients needing progressive care. It’s sometimes called step-down care, but Tim Pratt, RN, nurse manager of the MSPCU, prefers to think of progressive care as a “teeter-totter.” The unit’s nurses care for patients “coming up” the acuity scale, possibly to move on to intensive care, as well as others “coming down” from an ICU on their way a med/surg floor, he said.

The changeover was a $300,000 upgrade for telemetry equipment and cabling, but it required no extra training for the MSPCU’s 72 nurses, Pratt said. All are trained to provide progressive care for patients with a wide variety of needs, such as continuous cardiac drips, medications for severe and chronic pain, BIPAP and CPAP ventilation before intubation and more. The unit also cares for patients treated by the hospital’s Medical Emergency Team who don’t meet the criteria for ICU admission, Pratt said.

The bottom line? “We can take all patients and do anything necessary to care for them during the day,” he said.

At the same time, MSPCU nurses regularly consult with colleagues when patients have particular needs for which they haven’t had special training, such as chemotherapy infusion or Flolan treatment for serious respiratory issues. The MSPCU also works closely with its “sister unit,” the Cardiac Progressive Care Unit on the third floor of Anschutz Inpatient Pavilion 2, Pratt said.

Quick progression

The unit still provides care for med/surg patients, but the balance has already tipped toward those needing progressive care, said charge nurse Brenda Booth, RN. On a recent shift, Booth said, progressive care patients filled 30 of the 36 beds.

“We had expected the changeover to be more gradual, but it happened within a week,” Pratt said.

The patient mix varies not only from shift to shift but also during a shift, Booth said. That can call for “creative staffing” to ensure individual nurses don’t get too many high-acuity patients during a shift. Booth also reviews nurses’ recent assignments before scheduling shifts, rotating all of them through progressive care responsibilities.

The change has been welcomed by nurses and providers in the ICUs, Booth said. “They saw the need for it and the benefit,” she said. “It gives them the ability to move more patients safely to our unit so they can accommodate patient transfers. They are excited as much as we are.”

Getting more patients into progressive care was what hospital leadership envisioned when the MSPCU opened in May 2013, taking over the 10th floor when the cardiac units moved to AIP 2. With careful patient selection, it’s a boon for all concerned, Pratt added. Patients benefit when they are moved safely and promptly out of intensive care. It also shortens their length of stay, getting them home or to the next level of care quicker and helping the hospital to manage capacity as well as its clinical and financial resources more efficiently.

The change was a long time coming but worth the wait, Pratt said. “It was important to get this project done. This was our intention for the unit all along. We’re utilizing it to its full benefit.”

About the author

Tyler Smith is a freelance writer based in metro Denver.