Fifty-year-old Marvin Smith, an African American male with no significant history of heart disease, presented to the ED with 6/10 chest pain and diaphoresis. His heart monitor showed normal sinus rhythm, and ECG showed ST segment depression in the anterior leads. His troponin was positive, indicating an acute non-ST-segment elevation myocardial infarction (MI).

Five to 15 years ago, the ED nurse manager would have assigned Smith to a CCU bed. Today, as advanced technology supports higher-acuity stable patients in less-intensive environments, managers have other options. Since Smith is hemodynamically stable, he’s more likely to receive ongoing monitoring and therapy on the cardiac step-down unit.

Progressive care units (PCUs)—also called step-down, telemetry, intermediate care, and transitional care units—continue to grow in number as the patient acuity gap between critical care and medical/surgical care narrows. Optimally, patients should be transferred to where they can get the best care, without limiting their placement...

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