Clinical Decision Units

[flaerman]

Does anyone have CDU at their facilty, we are moving towards one at present. Does it work? Who staffs it, and who runs(director) it? Any pointers on what we would need to get ours set to be functional and useful????? Let me know---Paul

[MPHkatie]

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...

[amy]

...

[teeituptom, BSN, RN]

Howdy yall

From deep in the heart of Texas

We have a CDU also, but we call it the Emergency Department Observation Unit. It is managed by the ER docs and staffed with ER RNs,and the staffing pattern is set to deal with it, mostly. And we have some ER nurses who think that it is beneath them to do floor nursing. But it is part of the ER and ours to utilize and we do utilize it, Whether it watching asthmatics,CHF,or chest pains or dehydration or other problems we have guidelines and established protocols for it. And all nurses have to rotate thru it.The patients seem to like it, The rooms are set up just like regular rooms with all the amenities.Icluding a regular hosp bed, telephione. tv, private bathroom meals etc. Stays run from just a few hours to up to 12 hours. Most end up being discharged but some make it upstairs.

As far as being financialy rewarding for the hospital, Im sure it is otherwise they wouldnt keep it, however Ive seen no facts on this matter. The heaviest amount of flow through it is of course at night. It also serves as a home for the chemically impaired untikk they are sober enough to go home. Hopefully before they get ready to go into DTs.

main guidelines would be

1> have guidelines and protocols in place for it, and adhere to them.

2>Unless you set it up as a completely different unit, then all ER staff has to rotate through it.

3> all patients have to be worked up in the ER and cleared for admission to it.

4> No patients with vasoactive drips, they all meet criteria to go upstairs anyway.

5> all pts must me reassessd at least every 4 hours if not more often by the attending ED MD.

6> Dont let your nurse over their get overloaded, it isnt good for your nurses and it certainly isnt good for the patient either.

keep it in the short grass yall

teeituptom