Clinical Decision Unit

karoline · Apr 29, 2003

My hospital is opening a new 8 bed unit that will be called the "Clinical Decision Unit". Don't know why that title is being used. Anyways, patients will be admitted to this unit directly from the ER. This unit will be for patients that need very short term care and have an anticipated discharge of 24 hours or less. These extra beds have been open for some time and called the "additional care unit", providing badly needed beds during times of high census. Now will be a permanent unit with own staff. I did float to this unit a couple times and enjoyed the work. The patients were of low acuity and most admitted under observation status. Was wondering if anyone here has any experience working in such a unit? I did apply for a permanent position and have an interview in 10 days or so. Any feedback will be greatly appreciated.

Nurse Ratched, RN · Apr 29, 2003

Isn't that an interesting concept. I presume the "clinical decision unit" name is because "nobody will make a decision" unit and "should I stay or should I go" unit didn't sound as cool . So essentially these are just 23 hour observation patients. My best guess is that this is a way to maximize insurance coverage for people who are borderline in terms of having sufficient clinical data to justify admission but are just hinky enough that you feel nervous about letting them go.

I have no experience with this type of unit, but would be very interested in hearing from you how well it works as you hopefully get more experience in it. Good luck with the interview :).

Nurse Ratched, RN · Apr 29, 2003

Isn't that an interesting concept. I presume the "clinical decision unit" name is because "nobody will make a decision" unit and "should I stay or should I go" unit didn't sound as cool . So essentially these are just 23 hour observation patients. My best guess is that this is a way to maximize insurance coverage for people who are borderline in terms of having sufficient clinical data to justify admission but are just hinky enough that you feel nervous about letting them go.

I have no experience with this type of unit, but would be very interested in hearing from you how well it works as you hopefully get more experience in it. Good luck with the interview :).

jeannet83 · Apr 29, 2003

Hi, Karoline! Alot of larger ER's have Clinical Decision Units or CDU's. They are used for patients who are being admitted and are awaiting a bed to become availabe and/or for the 23 hour observation patient. It sounds like your CDU is really being used as an observational unit for folks being observed for 23 hours or less. I think the name CDU comes from the fact that the patient is being observed for 23 hours and then a clinical decision is made as to whether the patient can go home or is to be admitted. Alot of observational patients are chest pain patients who are going to have treadmill tests done the next morning and if they are negative they can go home. Or you may have the nausea/vomiting patient who needs a little more time for hydration and control of vomiting. I find observational patients alot of fun generally.

A CDU which is purely devoted to the admitted patient awaiting a bed assignment and can be a whole 'nother matter. Alot of times they are more sick, have lots of orders to be taken off and there is the constant shuffling of patients in and out of the CDU as patients arrive to await a bed and as patients leave as they get beds. Sometimes it is slower if the "house" is totally booked up and there are no admission beds available.

But again, it sounds like your CDU is going to be more like an Observational Unit which would be alot of fun to work in.

Hope this helps! Oh, and check out the Emergency Nurses Forum as there is a current thread there on Clinical Decision Units. You may get more info from that also.

Jeanne:)

jeannet83 · Apr 29, 2003

Hi, Karoline! Alot of larger ER's have Clinical Decision Units or CDU's. They are used for patients who are being admitted and are awaiting a bed to become availabe and/or for the 23 hour observation patient. It sounds like your CDU is really being used as an observational unit for folks being observed for 23 hours or less. I think the name CDU comes from the fact that the patient is being observed for 23 hours and then a clinical decision is made as to whether the patient can go home or is to be admitted. Alot of observational patients are chest pain patients who are going to have treadmill tests done the next morning and if they are negative they can go home. Or you may have the nausea/vomiting patient who needs a little more time for hydration and control of vomiting. I find observational patients alot of fun generally.

A CDU which is purely devoted to the admitted patient awaiting a bed assignment and can be a whole 'nother matter. Alot of times they are more sick, have lots of orders to be taken off and there is the constant shuffling of patients in and out of the CDU as patients arrive to await a bed and as patients leave as they get beds. Sometimes it is slower if the "house" is totally booked up and there are no admission beds available.

But again, it sounds like your CDU is going to be more like an Observational Unit which would be alot of fun to work in.

Hope this helps! Oh, and check out the Emergency Nurses Forum as there is a current thread there on Clinical Decision Units. You may get more info from that also.

Jeanne:)

amk1964 · Apr 29, 2003

well karoline i have done agency staffing in the CDU at an area HCA facility and found it unpredicatable. most of the time its not truly a short-stay unit, but an overflow when there are no beds. one day i had an exacer of chf, a dm out out of control, etc.. then the next time i had a vent [ post-arrest], a r/o mi, and a pedi head injury.....wow. i don't know if i care for that much variety in less than a week. i'm flexible, but there have to be some limits.

amk1964 · Apr 29, 2003

well karoline i have done agency staffing in the CDU at an area HCA facility and found it unpredicatable. most of the time its not truly a short-stay unit, but an overflow when there are no beds. one day i had an exacer of chf, a dm out out of control, etc.. then the next time i had a vent [ post-arrest], a r/o mi, and a pedi head injury.....wow. i don't know if i care for that much variety in less than a week. i'm flexible, but there have to be some limits.

jeannet83 · Apr 29, 2003

Karoline, amk brings up a good point. It will just have to be a question that you ask in your interview as to what type of acuity they are expecting to put in the CDU and what happens if a patient starts to turn sour.

In our facility, we have strict rules about who can and cannot come to the CDU. For instance, absolutely no ventilators, no unstable patients, no comabative or agitated patients, no one-to-one patients. Plus if a patient gets worse, they go right back to the ED promptly.

I would ask the interviewer what kind of patient population they expect, what would happen should a patient suddenly worsen, who would be the medical person in charge (ie, will there be a doctor or NP covering patients in this unit or will it be each patient's own PMD). Also ask if they have written guidelines yet for this unit and if you may look at them.

Each place is different as to how its CDU is run so I think it is worthwhile to go to the interview and check it out.

Good luck with the interview and keep us posted! Jeanne:)

jeannet83 · Apr 29, 2003

Karoline, amk brings up a good point. It will just have to be a question that you ask in your interview as to what type of acuity they are expecting to put in the CDU and what happens if a patient starts to turn sour.

In our facility, we have strict rules about who can and cannot come to the CDU. For instance, absolutely no ventilators, no unstable patients, no comabative or agitated patients, no one-to-one patients. Plus if a patient gets worse, they go right back to the ED promptly.

I would ask the interviewer what kind of patient population they expect, what would happen should a patient suddenly worsen, who would be the medical person in charge (ie, will there be a doctor or NP covering patients in this unit or will it be each patient's own PMD). Also ask if they have written guidelines yet for this unit and if you may look at them.

Each place is different as to how its CDU is run so I think it is worthwhile to go to the interview and check it out.

Good luck with the interview and keep us posted! Jeanne:)