Guidelines for Admission to the CDU



|Guidelines for Admission to the CDU |

|(See also Guidelines for Admission to the Chest Pain/Cardiac Emergency Center) |

| |

|Patient Eligibility |

|Access to CDU is only by written order of the Emergency Department MD (co-signed by ED Attending if resident order). |

|CDU admissions limited to those patients specifically deemed appropriate for short-term evaluation and therapy (up to 24 hours) and whose care |

|can be better managed in the CDU. At the discretion of the ED attending and resource nurse, criteria may be expanded to include those patients|

|admitted and awaiting inpatient bed placement. |

|Examples, but not limited to, of patients appropriate for CDU admissions: |

|Chest pain patients to be admitted with a somewhat limited workup needed, i.e. r/o with enzymes and treadmill testing. |

|CHF in the non ischemic, hemodynamically stable patient |

|Acute asthmatic attack |

|Diabetic ketoacidosis (uncomplicated) |

|Hypersmolar non-ketotic state |

|Acute exacerbation of chronic lung disease |

|Uncontrolled hypertension |

|Drug reactions non acute |

|Dehydration requiring intravenous repletion (e.g., secondary to vomiting, diarrhea, anorexia, etc.) |

|Infections, requiring short-term parenteral antibiotic therapy (e.g., cellulitis, pneumonia, urinary tract infection) |

|Conditions requiring short-term observation for potential deterioration of complications (e.g., head or abdominal trauma, abdominal pain |

|suggesting an acute abdominal process, certain neurological problems, gastrointestinal bleeding of uncertain nature of significance, etc.) |

|Other medical and surgical problems, with discharge anticipated within 24 hours. |

|Specific Guidelines |

|The Emergency Department evaluation shall serve as the admission note. |

|The patient shall be considered observation status as defined by the ED attending or on-site medical physician. |

|The ED attending admitting the patient to the CDU must complete CDU admission checklist. |

|Patient must be ambulatory. |

|Vital Signs must be stable: i.e. SBP > 90, Heart Rate >50, Oxygen Saturation > 90. |

|The resource nurse will inform the CDU RN who is receiving patient, regarding the decision to admit a patient to CDU. |

|All patients admitted to the CDU are the responsibility of the ED attending unless otherwise noted in the patient’s chart. |

|All APG patients will receive medical consultation by an APG hospiitalist. |

|All patients admitted as inpatients but being held secondary to lack of inpatient beds will have an admitting attending of record for the |

|admission and inpatient Housestaff will be called regarding patient care. |

|The patient record will reflect this. |

|Unoccupied beds in CDU may be used as fast track overflow as needed. |

|Frequent clinical re-evaluation (including periodic progress notes and at a minimum every 2-4 hour nursing documentation) as well as |

|appropriate diagnostic evaluation and therapy shall be undertaken by the Emergency Department Care team. |

|Every patient in CDU will be assigned a CDU primary RN. |

|The main ED primary RN will report to CDU primary RN and forward all ED record originals before or at time of transport. |

|All patients admitted to CDU as well as those admitted patients held in the main ED secondary to lack of inpatient beds (> 4 hours) will have |

|an inpatient nursing assessment tool completed. |

|Efforts shall be made to limit short stay admissions to 24 hours or less; if it becomes clear that this will be prolonged, patient shall be |

|transferred to an inpatient hospital unit. Note: If at the time of admission it is anticipated that the patient’s hospitalization will exceed |

|24 hours, a short stay admission shall be deferred in favor of routine hospital admission. |

|The ED attending shall review the patient’s stay in the CDU if in excess of 24 hours and the patient’s record will go to QA for review. |

|A medical discharge summary completed by responsible physician shall be required for each patient discharged directly from the CDU, as well as |

|appropriate patient discharge instructions and patient education tools as deemed appropriate by RN. |

|ED Attending to make physical rounds in CDU as appropriate. |

|The CDU RN will discharge the patient in the CDU after a discharge order and the MD of record documents follow-up information. |

|Other factors to consider when placing patient or measuring acuity of nursing are safety, language barriers, level of self care, etc, these |

|patients will be admitted to CDU at the discretion of the ED attending and resource nurse. |

|Adverse outcomes or difficulties in caring for these patients as well as as all admitted patients to CDU will be reviewed by the medical |

|director on a daily basis. . |

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