The Emergency Department Clinical Decision Unit (CDU) is an integral part of the Emergency Department (ED).Print version
Its sole use is for ED patients who require a short period of observation or treatment, typically for a maximum of 24 hours.
Staffing, responsibility and admission procedure
- The unit will be staffed by Emergency Department personnel.
- Medical responsibility lies with the duty emergency medicine consultant.
- A consultant or registrar in Emergency Medicine will undertake a review of all patients in the CDU every morning and afternoon. Further reviews will occur on an ad hoc basis.
- Patients will be admitted to the CDU at the behest of the duty emergency medicine consultant or registrar in consultation with senior nursing colleagues.
- The duty Consultant/Registrar should confirm trolley availability on the CDU and appropriateness of admission. They should ensure that an appropriate history has been recorded and a comprehensive clinical examination has been undertaken. The reason for admission and a management plan should be clearly documented. A medication, fluid and medical gas prescribing chart should be completed. A copy of the original ED notes should be placed with the CDU documentation.
- Patients must have essential wound care prior to transfer to the CDU*.
- Patients who have specific medical conditions will be referred early to the appropriate in-patient team.
The following cases are not suitable for the CDU
- Psychotic or extremely violent patients
- Patients judged to be at extreme risk of suicide
- Complex medical problems (e.g. Diabetic Keto-Acidosis)
- Unstable physiological parameters (e.g. sustained tachycardia)
- Obstetric and gynaecological cases
- Patients who are unlikely to be fit for discharge within 24 hours
- Patients who are under the active ** care of other in-patient consultants (unless prior consultation with specific attending team Registrar)
Criteria for admission.
The following sorts of cases may be suitable for management in the CDU:
- Deliberate self-harm/overdose
- Minor traumatic brain injury
- “Rule out” subarachnoid haemorrhage
- Minor trauma requiring analgesia e.g. soft tissue injuries
- Acute soft tissue infection e.g. cellulitis
- Alcohol intoxication
- Acute allergic disorders (e.g. treated anaphylaxis or angio-oedema)
- Victims of high-energy trauma without clear diagnoses
Referral to other specialties
- If it transpires that CDU patients require more than 24 hours hospital care, they will be referred to the duty in-house consultant at that stage. For example, a patient admitted to the CDU on a Sunday, but found on the Monday to warrant continuing hospitalization, will be referred to the relevant Monday on-take consultant and transferred to an in-hospital bed after assessment by the admitting team.
- The relevant in-patient teams will be informed prior to discharge of patients who were admitted with a specific “medical” problem e.g. prior to discharge, the endocrine team will be made aware of known diabetic patients admitted with hypoglycaemi
- Constant efforts will be made to minimize the length of time patients spend on trolleys.
- The “trolley wait time” will be recorded on all patients (both those in the main Emergency Department and those in CDU).
- CDU patients who require continuing in-patient care (i.e. beyond 24 hours) should be transferred back to the main ED or directly to an in-hospital area with agreement by the in-patient team.
CDU Performance Assessment
- CDU activity will be subject to continuous scrutiny. Data will be collected every month regarding the following:
- Daily trolley occupancy rate.
- Mean length of CDU stay.
- Diagnosis on admission and discharge.
- Deaths on the CDU (or in former CDU patients).
- Patients who have remained on the CDU for more that 24 hours.
- Critical incident reports.
When the CDU is full, otherwise “CDU suitable” patients (e.g. DSH patients) will be referred directly to the appropriate duty in-patient team.
(*) Wound debridement or closure by ED staff. Patients requiring operative intervention will be admitted to an in-patient bed. Such patients will not return from theatre to the CDU.
(**) Admitted to in-patient bed within last six months or seen in out-patients (with same problem) within last two years