A hospital we work with had this quesiton about SCIP-inf-9 or NQF 0453 (aka CMS 178). In the past the hospital relied on their vendor to identify the ICU departments needed for this measure. Now their vendor is expecting them to define it. They have a few areas to consider: 1. Adult ICU is a given. They are planning to include them 2. Pediatric ICU. Should they be included? 3. Step down units are units that take “sicker” patients from a critical care unit than a regular med/surg unit does. For example the transitional trauma unit takes patients from the trauma/neuro ICU when their condition is downgraded. Should they be included for this measure? 4. Depending on the answer to include/exclude step down units, how should they handle patients who stay on a critical care unit, but are handled as step down patients. For example, patients in the Burn Center critical care unit usually stay on that unit when their status is downgraded, rather than move them to a step down unit?