We have just opened one about 5-6 months ago. unfortunately, ALL the nurses HATE it with a passion, so if you could hire other staff that would be my first reccomendation.
Second reccomendation- have protocols and guidelines for what can and cannot go into observation. When we first started, we had a lot of "dumps" with difficult patients, and some patients who really should have been admitted (I intubated a few in the decision unit- guess they ruled in for needing admission).Now we have about 20 protocols of what we can take and what we can't take, which has cut down on admitting frequent fliers to get them out of the hair, and on totally inappropriate admissions.
third rec: if you are going to staff it with ED staff, minimize or make the paper work as close to identical as possible. We have floor charting and most people haven't worked on the floor, so the paper work is very difficult to use.
4th: there may be some staffers who prefer the unit: those with injury who need light duty, etc, our pregnant staffers have requested the unit.
Our CDU is not making the money it was expected to, last weekend I worked and there were only 2-6 patients in a unit designed to hold 12. So, I am wondering how the study for it's feasibility was completed, I also imagine that during flu season, it well be enormously overwhelmed, as dehydraton is one of the protocols.
The director is an MD and it is staffed by PA's.
On the flip side, our patients usually really enjoy the CDU because it has TV's and phonesnin each room, as well as regular beds. SO, the patients really like it, but we just aren't making a profit... Good Luck, I sure do wish we didn't have ours however, it is really really, not fun to work there...