A dramatic increase in acuity. Many cardiac drips and often heated high flow and BIPAP.
Acuity, ICU 1:1 or 1:2 depending upon acuity. PCU/Stepdown 1:3 because they may be stable now but require frequent monitoring and assessing, med/surg 1:4-5 acuity is less but quantity is more, plus more PO meds, more educating, more of a turn over.
Med Surg will have lower acuity patients, no one who is very "sick" or needs a lot of 1:1 care. You have more patients, the normal ratio is 1:5-6 (in my experience), but with Covid it may be more. PCU/Stepdown units have higher acuity patients. Depending on hospital size you could see - new trachs, trach vents, chest tubes, high flow oxygen, unstable hear rhythms, more dangerous drips (Cardizem, Amio, Insulin, Heparin, etc...), or patients with a lot of wound care. Patient Ratios before Covid were 1:2-3, but since Covid it's been more 1:3-5. Hope this helped!
Crirical patient go to ICU, then PCU/ step down/IMU,( when a little stable), then when they are even more stable, then go to M/S
ICU>PCU>?M/S floor
PCU is usually a step down from Intensive Care and has telemetry capabilities. A more focused care with specialists. Sometimes more "lines" cvp, pleurex catheters, peritoneal dialysis, or chest tubes.
Medical surgical patients usually tend to be more stable and in need of some post-surgical or a close call event monitoring in the hospital to determine whether they can go home safely or be admitted for a longer period of time. Patients that have cellulitis, need HD if AV fistula had previously malfunctioned, unstable blood sugars, s/p appendectomy, pregnant mother with Hyperemesis gravidarum, an infection that's not healing properly in a diabetic Patient.....However step-down Patients may need closer observation to keep an eye on some abnormal labs like potassium, a post- Stent placement on a Patients that just had an angiogram, NSTEMI /STEMI Patients on heparin drip waiting for a cardiologist to determine the need for stress test or angiogram, PE patients that is symptomatic, blood disorder problems like low platelets or low hgb with no source of bleeding, ...
Tele, more complex pts, s/p cath lab, cabg, ppm things like this
The ratio is different. Think of it like the inbetween patients for icu and medsurg. The ratio that I had for step down was 1:3 or 1:4 depending on acuity.
The amount of drug seekers you have to treat.
