At most hospitals your child will transition to an acute care unit after leaving the ICU. Acute care – sometimes called “cardiac acute care” or “stepdown” – has specialized equipment and staff to monitor your child and provide ongoing cardiac care.

Your child will continue to recover in acute care until they are discharged. During this time, you will gradually learn the skills you need to care for your child at home.

While it can feel like an abrupt move to acute care – and you might not be prepared – it’s important to trust the care team’s decision. After close monitoring, they believe your child is well enough to leave the ICU and ready for the final stage of recovery in the hospital.

This move comes when your family has been through a period of strain that can take an emotional toll on anyone. Many parents find the initial transition from the ICU to acute care particularly challenging.

It may take you some time to adjust to a new environment where your child is not as intensely monitored. Getting to know your care team and how the acute care unit works will help you adjust to the changes.

What to Expect in Acute Care

  • The ratio of care team members to patients may be different than in the ICU

    Nurses often have more than one patient in the acute care unit, so they cannot constantly be at your child’s bedside. This can feel very different after all of the attention that your child received in the ICU.

  • The transition may be difficult for you

    It’s common for parents to have mixed feelings about moving to acute care. While you know that leaving the ICU is a good sign, you deeply trust the ICU team that carried your child through the ups and downs after surgery. You may have fears about leaving the safe space where your child had a dedicated nurse. Talk with your care team if you are struggling with this transition.

  • Your child’s vitals are still closely monitored

    Even though the care looks different from the ICU, you should feel comforted that your child will be monitored appropriately. In addition to regular visits from the cardiology team, the nurses remotely track your child’s vitals when they are not in the room. Ask your nurse how to notify the team if you notice a sudden change in your child’s status and need a quick response.

  • The care team specializes in transition care

    The nurses caring for your child are specially trained to treat children with heart conditions. They know the warning signs and protocols for when a child requires more focused care, and they are equipped to handle urgent needs if there’s a rapid change in your child’s condition. Each day the care team will do rounds to make a plan for your child, just like they do in the ICU. This is a great time for you to communicate with the care team about your child’s progress and goals in their recovery.

  • There is some medical equipment

    Your child will probably be hooked up to a cardiac monitor so that the physicians and nursing staff can closely monitor their vitals. Other equipment that your child may need in acute care can include oxygen and oxygen tubing, IV medications, and IV fluids.

  • Your quality of life improves

    Acute care generally provides a change in surroundings with many benefits over the ICU. This includes more privacy, less noise, and a gradual return to more “normal” routines.

  • You learn skills to care for your child at home

    Making sure that you feel comfortable providing care for your child at home is a central goal of your stay in acute care. The nurses are experts at teaching you the specific skills you will need to care for your child after discharge. Going to acute care is a major step towards your independence from the hospital…and towards the rest of your life with your child.

What You Need to Know in Acute Care

  • How to reach your nurse, unit clerk, and other important care team members through the call light or by phone

  • What hours the nurses work their shifts and when they change shifts

  • How to prevent falls – including side-rails on the bed, non-skid socks

  • Handwashing and infection control practices to keep your child healthy

  • How you will get information about your child’s care plan and condition updates – what time the physicians do daily rounds, when you will have family care meetings

  • Where there’s a sleeping space for parents

  • Visitor policies

  • How to report changes in your child’s status

  • Rules for ordering food

  • What kind of therapies your child will have – occupational, physical, speech

  • How the social worker can help you – with issues such as insurance, Medicaid, housing, and disability

  • Play and school opportunities – such as playrooms, off unit policies, child life specialists, music and art therapy, and in-hospital schools

  • A discharge checklist

Moving to Acute Care

It seems shocking at first. Why don’t we have a nurse in here all the time, because that’s what you’ve been used to. But it’s because your child is more stable, which is a good thing.

Rachel, CHD Parent

PARENT TIPRemember to Take Time for Yourself in Acute Care

If your child’s nurse in the acute care unit has more than one patient, you may find it more challenging to balance caring for yourself and caring for your child. When you always want someone to be with them, it can be difficult to step away for a moment alone, or to get food, connect with family, or take care of work.

One of the best things you can do to care for your child is to care for yourself. This is especially true after your long journey through surgery and the ICU. Now that your child is more stable, give yourself some breathing room to focus on self-care.

Most acute care units have practical and emotional resources to support you. You can often coordinate with your child’s nurse to allow you to leave and relax for a bit. Soon it will just be you and your child at home, so use this opportunity to take care of yourself while the nurses can help.

FAQs

If you are feeling this way, please talk with your nurse, social worker, or another person on the care team about the changes that are troubling you. The best thing you can do to relieve any fears is to understand why the team made important decisions like reducing your child’s monitoring or decreasing their medication. Remember – the move to acute care is a step towards taking your child home!

The plan for how often your child’s vital signs are taken depends on the level of care your physicians recommend. The care team will routinely take your child’s temperature, measure their blood pressure, and weigh them on a scale. Most acute care units closely measure your child’s liquid and nutrition intake as well as how much they are urinating.

Most hospitals attempt to minimize sleeping interruptions and “cluster” care for your child whenever possible, but there may still be times when your child will be woken up for medications or vitals.

Ask your nursing team to explain how they monitor vitals. If needed, you can work together to come up with a plan that balances your child’s health and safety with restful recovery. Often a little bit of planning and coordination with your nurse can make a significant improvement in your child’s routine.

While every child’s condition is different, here are some things you commonly see in an acute care room:

  • Chest tube: A flexible tube that drains extra fluids from around the lungs
  • Drips: Medicine that runs non-stop into the body through an IV
  • Foley: A tube leading to the bladder to get urine out
  • IV: A small, flexible tube that sits in your vein to give fluids and medicines
  • PICC line (Peripherally inserted central catheter): A type of IV that sits close to your heart placed by specially trained nurses to gives fluids or medicines for a longer time

Knowing how much your child is urinating compared to how much they are drinking or getting via intravenous (IV) fluids is an important way that the medical team monitors your child’s condition. If a child keeps too much fluid inside their body, they may develop difficulties breathing and their heart may get overworked. That’s why the care team watches fluids so closely while your child is recovering. After a while, this monitoring will stop when the team sees that your child is consistently managing their fluid balance.

You may be asked to help the team monitor your child’s input and output. Many acute care units have a worksheet in each room to record intake volume and output volume.

If you have a baby, this might mean collecting diapers for the nurse to weigh each shift, or your nurse may train you on how to weigh and record diapers. For older children, urine is collected in a special bucket that sits under the toilet seat.

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