Guidelines for Admission to the CDU

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

  1. Access to CDU is only by written order of the Emergency Department MD (co-signed by ED Attending if resident order).
  2. 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.
  1. Examples, but not limited to, of patients appropriate for CDU admissions:
  2. Chest pain patients to be admitted with a somewhat limited workup needed, i.e. r/o with enzymes and treadmill testing.
  3. CHF in the non ischemic, hemodynamically stable patient
  4. Acute asthmatic attack
  5. Diabetic ketoacidosis (uncomplicated)
  6. Hypersmolar non-ketotic state
  7. Acute exacerbation of chronic lung disease
  8. Uncontrolled hypertension
  9. Drug reactions non acute
  10. Dehydration requiring intravenous repletion (e.g., secondary to vomiting, diarrhea, anorexia, etc.)
  11. Infections, requiring short-term parenteral antibiotic therapy (e.g., cellulitis, pneumonia, urinary tract infection)
  12. 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.)
  13. Other medical and surgical problems, with discharge anticipated within 24 hours.
  14. Specific Guidelines
  15. The Emergency Department evaluation shall serve as the admission note.
  16. The patient shall be considered observation status as defined by the ED attending or on-site medical physician.
  17. The ED attending admitting the patient to the CDU must complete CDU admission checklist.
  18. Patient must be ambulatory.
  19. Vital Signs must be stable: i.e. SBP 90, Heart Rate >50, Oxygen Saturation > 90.
  20. The resource nurse will inform the CDU RN who is receiving patient, regarding the decision to admit a patient to CDU.
  21. All patients admitted to the CDU are the responsibility of the ED attending unless otherwise noted in the patient’s chart.
  22. All APG patients will receive medical consultation by an APG hospiitalist.
  23. 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.
  24. The patient record will reflect this.
  25. Unoccupied beds in CDU may be used as fast track overflow as needed.
  26. 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.
  27. Every patient in CDU will be assigned a CDU primary RN.
  28. The main ED primary RN will report to CDU primary RN and forward all ED record originals before or at time of transport.
  29. 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.
  30. 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.
  31. 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.
  32. 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.
  33. ED Attending to make physical rounds in CDU as appropriate.
  34. The CDU RN will discharge the patient in the CDU after a discharge order and the MD of record documents follow-up information.
  35. 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.
  36. 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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