Step-Down Facility

The term step-down facility or step-down unit is a generic term that can have various meanings in different settings. It is used to designate movement to a less intense level of care where the patient-to-nurse ratio is greater. A step-down unit can be used after a hospitalization for [Page 522]patients who are not strong enough to return home. These facilities are also called subacute or transitional units and are usually located in a hospital or nursing home.

A step-down unit can also be a transition between intensive care and a medical or surgical floor in a hospital. Examples include (a) a postcoronary unit for a patient who suffered a heart attack several days previously or (b) a step-down surgical unit for a surgical patient who no longer needs intensive care.

In recent years, lengths of hospital stays are decreasing, and hospital step-down units are less common. Moving patients from room to room incurs additional costs and disrupts bonds between patients and nurses. Nurses on the general medical floors are now trained to care for patients who are coming directly from intensive care. Patient-focused care encourages bringing the necessary care to the patient, rather than moving the patient to various sites as needs change. Step-down units within hospitals can disrupt patient-centered care.