"Subacute" or observation area of ER

Specialties Emergency


OK, ER nurses :)

Last nite I was assigned to a subacute area of a hospital that I recently started going to as an agency RN. This is a suburban hospital outside Philadelphia and a level 2 trauma center. The subacute/observation area was set up to hold patients for more than 24 hours (if needed) when there are no beds available "in the house". I had 3 patients, one of the 3 on monitor, and picked up a fourth about 2.5 hours into the shift. In this particular hospital, this subacute area is staffed mostly by agency or traveler RN's b/c the regular staff "hate" working there. So I'm curious as to how many ER's have this kind of "subacute" unit as part of their ER and how is it staffed? Do the "regular" ER nurses float there or is it staffed by RN's who have telemetry or med-surg experience?

Will be curious to hear everyone's thoughts on this


Newly minted MSN


1 Article; 2,394 Posts

Specializes in Everything except surgery.

Hi Laurie

I have seen OBS units like this before, in Brooke Army Medical Center(BAMC), and another hospital in Seattle. It was also staffed by agency, and travelers. Most the staff didn't like being in there, except for those going to back to school. I really didn't care for it, as it was pretty boring most of the time. When I had to work in there, I had to find things to keep me from falling asleep!

We got mostly the 23hr or less OBS pts. And it was rare to have more than one of two pts. and only once did I have four. This unit was staffed by ICU/ER experienced nurses.

The hospital in the Seattle area is called a clinical decision unit. They required ICU/Tele experience. Right now they're aggressively ooking for RN/LPNs to staff this unit. I guess they're probably using agency/travelers to staff it now, as they told my recruiter they would consider me for the position. I have a feeling I wouldn't have been bored there though.:cool:


30 Posts

Hey, I worked in an ER with the same. It was called EACU. Emerg. acute care unit. It was an extention of the ER. When it opened it was staffed with all ER staff as it was meant to be under the same management as the ER. Most full time staffers were cross trained in both depts and had the option to pick up extra shifts on either dept.. I left shortly after it opened so I don't know how things are now. A lot of ER's on the east coast have them.


64 Posts

Hi! We have two different areas that are subacute. One is right in our ER and is also called CDU or Clinical Decision Unit. It is ideally for patients who are waiting to get an inpatient bed. Total patient capacity is up to 12 patients with each nurse having 6 patients each.

The other unit is also part of the ER dept. but on another floor. It is called the Observation Unit. It is ideally for patients who are OBS (not admitted but 23 hours or less). Holds 12 patients also with same RN:pt ratio.

We have some travelers who work with us but basically everyone in ED has to go to these units. Travelers are not forced to go there repetively. Some people actually do like to go there but most are not too fond of it.

Hope this helps! Jeanne :)


151 Posts

Specializes in M/S, Onc, PCU, ER, ICU, Nsg Sup., Neuro.

We have an 11 bed CDU/Clinical Decision Unit that is purely at the discretion of the ER charge nurse', to assign 23 hr observation pt's. Pt's are not normally direct admitted there and beds are not assigned by either the administrative supervisors nor the admissions nurse. It is staffed by PCU/Telemetry nurses and right now we are almost at full staff capacity for it. On occasions I or one of the other charge nurses have to rotate one of our own ER staff there, but will most likely an agency nurse first if possible. In our ER we rotate only to either the CDU or to the fast-track area.---Paul


15 Posts

Hmm, sounds like most of you work in a city hospital. I work in a extremem rural setting. One RN on during nights, I don't have an observation "Unit". I do however, obs them here with me in the ER. This hospital doesn't have surgery or icu technology, but the ER is usually used as icu. Good thing i have some icu experience!... Our inpatient nurses are currently rebeling against the ER cause we took one of their cna's. I can not convince these inpatient nurses to accept more than 2 pt's per RN. It gets quite fustrating when i have 6 or more patients....and this is ER. I usually have at the least of one obs per night, i have had up to 5 obs, that leaves me with ONE bed to run the ER. Crazy at times. All the criticals, of course, are flown out via fixed or heli's. I like this idea of a separate unit to house the obs.



8 Posts

The hospital that I work at just recently in the last year had an OBS unit built. It has 8 beds, and is staffed by full time employees that only work in the OBS unit. But if there is a shortage we get pulled from the ER or Peds ER to fill in if the need arises. Sometimes it is nice, esp if it has been really rough in the ER. But it can be very boring :zzzzz

:D :D

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