Clinical Outcomes of Patients Managed in a Temporary COVID-19 Step-Down Unit

Background During the coronavirus disease 2019 (COVID-19) pandemic, unprecedented surges of patients strained healthcare resources, especially intensive care units (ICUs), which were quickly saturated by patients with respiratory failure. To inform future responses, we conducted a retrospective analysis of patient outcome data from a temporary COVID-19 transitional care/step-down unit (TCU) we implemented during January-February 2021. Methods Our TCU was embedded on a medical-surgical floor at our academic hospital institution to offload ICU patients with stable or improving respiratory failure, who still required heated humidified high-flow nasal cannula (HHHFNC) and/or noninvasive positive pressure ventilation (NIPPV). Our Hospital Medicine and Critical Care service lines devised specific clinical criteria for patient selection to the unit. We recruited personnel with experience in HHHFNC and NIPPV and ensured that a physician or Advanced Practice Provider was virtually always physically present on the unit. We performed descriptive statistical analysis of patient outcomes (disposition, length of stay, and readmission) and demographic characteristics (age, sex, and baseline comorbidities). Results Twenty-six patients were treated in the COVID-19 TCU. At baseline, patients had a mean of 2.8 comorbidities per person (range: 0-7, median 3). Eight patients (31%) were female and 18 (69%) were male. The mean age of the patients was 70.9 years (range: 32-94 years, median 70.5). Five (19.2%) were downgraded to the general medical ward, 17 (65.4%) were discharged to home or another medical facility in good condition, and four (15.4%) were provided comfort care (one died awaiting transport to hospice). The mean TCU length of stay was 7.6 days, and the mean hospital length of stay was 16 days. Only one patient required readmission within one month. No patients experienced unexpected cardiopulmonary arrest or required transfer back to the ICU. Conclusions Our TCU, embedded within a medical-surgical floor, effectively and safely liberated ICU beds during a pandemic. Using agreed-upon clinical criteria for appropriate transfer to the TCU and appropriate staffing, we conserved critical care resources and improved patient flow without major adverse events or ICU readmissions.