| Abstract: |
At this 514 bed New York City Magnet recognized, NCI-designated Comprehensive Cancer Center the COVID-19 pandemic had a significant impact on the oncology population, propelling the creation of a formalized step-down unit (SDU). At the start of the pandemic, it was identified that more intensive care unit (ICU) beds were needed to accommodate the surge of critically ill COVID-19 patients. The thoracic surgery unit was identified as the target unit for over-flow of ICU beds. The thoracic surgery nurses were sent to a critical care bootcamp class for didactic education, focusing on the evidenced-based practice guidelines for critical care nursing. While caring for the critically ill COVID-19 patients, the surgical oncology nurses worked alongside ICU registered nurses (RNs) to expand on their newly gained knowledge and refine their critical care skills. Real time education was provided, focusing on drip titration, arterial lines, and advanced airway management. As the number of COVID-19 patients declined, there was an recognized need to maintain these critical care beds within the institution. A decision was made to permanently transition the thoracic surgery unit to a step-down unit (SDU). Two new critical care services were created to function as an extension of the ICU. SDU team C focused on patients requiring vasopressor support and/ or sedatives, while SDU team D focused on patients with tracheostomies requiring mechanical ventilation. The newly created critical care services allowed our oncology patients to receive higher levels of care, without being admitted in the ICU. From July 2020 to July 2021, SDU-C had 319 admissions, with 23% of the patients admitted from ICU. Within this same time frame, SDU-D had 34 patients admitted, with 88% of them admitted from ICU. This data revealed the need for additional critical care beds. Creation of this step-down service has allowed the institution to decant the ICU and assist with patient flow needs. To assist with the transition of these two critical care services, a standard of care was created by an expert-level nurse in collaboration with nursing leadership, to guide the nurses and advanced practice providers with admission criteria and frequency of nursing care. The newly created SDU allowed for nurses to retain their critical care knowledge, while simultaneously allowing for closer monitoring for our oncology patient population. |
