A step-down unit (SDU) is an intermediate level of care between the intensive care unit (ICU) and the general medical-surgical wards. Patients in SDUs are not usually stable enough to be on a general medical-surgical floor, but they do not require rigorous observation and treatment in the ICU either. Instead, they are at a halfway point in their recovery. SDUs fill a gap between ICU and the MedSurg/Tele units by providing a lower level of care than ICU. SDUs can also be called intermediate care units, transitional care units, progressive care units, or specialty care units such as surgical, medical, neuro, coronary care units, or other names, depending on their population.

SDUs are staffed at a higher nurse to patient ratio than general medical-surgical wards but not as high as ICUs. Nurses in SDUs must treat patients with various conditions as they recover from serious injuries, illnesses, or surgeries. They must hold a valid, unencumbered nurse’s license in their state and have several years of experience working with patients in critical or acute care.

SDUs provide a heightened level of observation and care, including management of life-sustaining medical equipment and moderate to advanced wound care. Patients in SDUs include those recovering from acute injuries, sudden and chronic illnesses, surgical procedures, heart attacks, strokes, and more. It can also include patients on long-term ventilation, non-invasive ventilation, and those who require cardiac monitoring.

In summary, a step-down unit is an intermediate level of care between the ICU and general medical-surgical wards. It provides a lower level of care than the ICU but a higher level of care than general medical-surgical wards. SDUs are staffed at a higher nurse to patient ratio than general medical-surgical wards but not as high as ICUs. Nurses in SDUs must hold a valid, unencumbered nurse’s license in their state and have several years of experience working with patients in critical or acute care.