THE SYNERGY MODEL IN PRACTICE Promoting Synergy in Progressive Care

Progressive care units (PCUs) are serving as a safe portal for patients who are transferred from the intensive care unit (ICU). Recently, patients who are now cared for in PCUs were cared for in the ICU. However, healthcare systems have changed. In the past decade, challenges for resources occurred, which, combined with the aging population and accompanying healthcare risks, have limited the ICU environment to extremely ill patients. PCUs in each hospital have a predetermined mission with a written structure for care. Specific admission criteria determine what patients are appropriate for care in the PCU. Specialty units may be for telemetry, with cardiac focus, or ventilator-de pendent patients and those with complex pulmonary needs. Classification tools are used to record the amount of time nurses spend caring for a specific patient; for example, the amount of time to bathe the patient, get him or her out of bed, ambulate, and administer treatments and medication. The time needed to reassure the patient and family, provide emotional support, and develop a plan of care is not included in these classifications. In this article, we describe a 26-bed pulmonary step-down unit in a 526-bed community hospital in western New York. The patient profile for this unit includes hemodynamic stability with ongoing need for supervision of airway needs, such as patients who have undergone surgery or survived a critical illness and have ongoing need for ventilator support, and with a tracheostomy tube in place. The patient profile also includes those with a respiratory illness who require frequent assessment, treatments, medications, and complex oxygen delivery such as noninvasive assisted ventilation (eg, continuous positive airway pressure or bilevel positive airway pressure).