Progressive Care (PCU) vs. Intensive Care Unit (ICU): What's the Difference?

The progressive care unit (PCU) and intensive care unit (ICU) are units that care for some of the sickest patients in the hospital. The most critically ill patients stay in the ICU and often need mechanical ventilation. Patients in the PCU still require specialized care and continuous monitoring. However, they do not need 24/7 care from an intensivist.

Knowing the differences and similarities between the PCU and ICU can help you decide if one of these units is a good fit for you. Continue reading to discover the key PCU vs ICU differences.

Levels in Acute Care Hospitals Explained

An acute care hospital is a short-term facility with the equipment and required medical staff to diagnose, care for, and treat an array of acute conditions, including injuries. There are four main levels in an acute care hospital:

• Critical Care: Also referred to as the intensive care unit (ICU), this unit provides care for those experiencing severe, life-threatening medical conditions, including cardiopulmonary arrest, severe trauma, sepsis, and respiratory failure.
  
  
• Intermediate Care: The intermediate care unit is a step-down unit providing care to patients after the intensive care unit. Patients still require continuous monitoring.
  
  
• Acute Care: An acute care unit is a specialized medical unit that provides short-term care for patients needing monitoring, treatments, or procedures periodically.
  
  
• Observation: An observation unit is for short-term monitoring to determine if a patient needs admission to the hospital. 

What is a Progressive Care Unit (PCU)?

Acute care hospitals consider the PCU a critical care unit, offering step-down level care to patients transitioning out of an ICU. Some patients can be directly admitted to the PCU, but this is rare in most hospitals. The PCU is usually next to the ICU because patients may need to return to ICU care depending on their status.

As a bridge between the ICU and the medical-surgical unit, PCUs provide continuous monitoring to patients. PCU patients are considered critical but stable. Specific patients found in the PCU are those suffering from:

• Heart attack
• Pneumonia
• Chronis Wounds
• Sepsis
• Complications from diabetes
• COPD exacerbations
• Seizures
• Traumatic brain injuries (TBI)
• Transient ischemic attacks (TIA)
• Critical infections

Nurses caring for patients in the PCU will have a higher level of training than medical-surgical nurses. Some hospitals will train PCU nurses in the same manner as those working in the ICU. Factors like hospital unionization and patient acuity determine staffing ratios in the unit. Typically, PCU staffing ratios are 1:3 or 1:4.

What is an Intensive Care Unit (ICU)?

The ICU is a highly specialized department within the hospital where patients receive round-the-clock care from a multidisciplinary team of intensivists and intensive care nurses. ICU patients are critically ill, have severe injuries, or need support for one or more of their body systems.

Specific patients being cared for in the ICU include those suffering from:

•  Respiratory failure
• Sepsis
• Heart failure
• Stroke
• GI bleeds
• TBI
• Cancer
• Drug overdose
• Complications from Diabetes
• Trauma injuries
• Surgeries

Patients are connected to a centralized monitoring system 24/7, are usually intubated and require mechanical ventilation, may need dialysis or ECMO, and have multiple IV lines.  They require the highest level of monitoring in the hospital. So, ICU staff-to-patient ratios are typically 1:1 or 1:2, depending on the patient’s acuity. 

A multidisciplinary team of healthcare workers cares for ICU patients, including:

• ICU nurses
• Medical intensivists 
• Respiratory therapist
• Pharmacists
• Dietician
• Physical therapist
• Occupational therapists
• Social workers
• Case management

The various specialists required to treat ICU patients must hold multidisciplinary rounds daily and encourage families to participate. These rounds make sure that all team members are on the same page when caring for the patients.

What’s the Difference Between PCU vs ICU?

The PCU and ICU units serve different patient populations. Medical staff use algorithms, patient diagnoses, and their surgical histories to determine which unit is appropriate.

Patient Populations

Patients in the ICU are critically ill and require continuous monitoring from highly trained critical care nurses and intensivists. The sickest patients in the hospital receive treatment in the ICU. The ICU is one unit where patients frequently code and sometimes pass away. 

As a step-down unit from the ICU, the PCU has patients who are still quite sick and complex. They require more help than patients in a medical-surgical unit.

Staffing

Both units will have a centralized nurses' station, and oftentimes, nurses will have advanced training. ICU nurses are also specifically trained and oriented to endotracheal breathing tubes, mechanical ventilation, ECMO, dialysis, and total body cooling.

Staffing ratios within the ICU and PCU are different because of the acuity of the patients. Typically, in the ICU, staff-to-patient ratios will be 1:1 or 1:2, but various factors can alter this. Nurses in the PCU will care for 3-5 patients, depending on the patients' acuity and the daily care plan.

PCU vs ICU Considerations

ICU and PCU nurses will have similar training because of the level of care provided. PCU patients may need less overall help with specific things, such as using the bathroom. However, their diagnoses or the complexity of their disease process may put them at a higher risk for deterioration.

Some hospitals, depending on their level, may have multiple PCUs, such as cardiac, pediatric, respiratory, or gastrointestinal PCU care. Others will have a general PCU that will admit all patients. 

The future of healthcare is ever-changing, and technology advances may have significant implications for the ICU and PCU.

Telemedicine

In recent years, telemedicine has begun changing the landscape of medicine and nursing. However, it hasn't been as prevalent in the ICU and PCU because of the complexity of the patients. However, some healthcare systems are implementing telemedicine with specialists such as dermatology and immunology.

Via telemedicine, medical doctors can provide examinations via remote video for some of the lesser specialties. To keep up with these changes, bedside nurses will need to learn to operate telemedicine equipment. They will assist in providing pertinent patient information to telemedicine providers and help assess patients in real-time.

Artificial Intelligence

Artificial intelligence (AI) can make some of the most profound impacts on healthcare and nursing. Algorithms are specifically designed to analyze patient data, including vital signs, laboratory results, and radiographic images. AI can also predict possible deterioration in patients and patterns that may lead to a diagnosis.

Robotics

Some hospitals in the US are already implementing nurse robots like Moxi to assist healthcare teams. Moxi is outfitted with modern sensors, cameras, and artificial intelligence algorithms that allow it to roam healthcare facilities autonomously. It can engage with people and complete non-patient-facing tasks such as delivering lab specimens and supplies or collecting soiled linens.

FAQs

• What are the main responsibilities of nurses in a PCU?
  

  • PCU nurses monitor patients’ condition, administer medication, including pain medication, collaborate with other healthcare professionals, conduct patient and family education, and provide wound and incisional care. 

• How does the staffing in an ICU differ from that in a PCU?
  

  • The nurse-to-patient ratio is typically 1:3 or 1:4 in the PCU. In the ICU, it is 1:1 or 1:2.

• What types of patients are typically in a PCU?
  

  • Patients in the PCU still require continuous monitoring but are not as gravely ill as those in the ICU. Many patients are transferred from the ICU to the PCU when they do not necessarily need round-the-clock care from a team of providers and intensivists.

• How does the level of monitoring in an ICU compare to that in a  PCU?
  

  • Monitoring will be very similar in both units, but patients in the ICU may be intubated and require mechanical ventilation, which requires a specific time of monitoring. VADs, ECMO, and dialysis are other common monitoring and treatment devices seen in the ICU and not the PCU. 

• What are the most common interventions used in a PCU?
  

  • The most common interventions in the PCU are supplemental oxygen, IV access, pain medication administration, and EKGs. 

• Is PCU considered critical care?
  

  • Yes and no. Some healthcare systems consider the PCU critical care because healthcare providers must continuously monitor the patients. Ultimately, how the PCU is classified depends on the healthcare system.