A Clinical Decision Unit (CDU) is a designated area for Emergency Department (ED) patients who require testing, treatment, and observational medical management for up to 12hrs. Only patients that meet well-defined criteria where there is an expectation that the patient should be able to safely return home and avoid hospital inpatient admission should be transferred to a CDU.
The ED at the Royal Devon & Exeter NHS Foundation Trust (RD&E) is one of the only departments in England seeing over 100,000 patients a year without a CDU.
This project sought to identify the optimum size and impact of a potential CDU.
The method
To understand the patient journey through the department, a pathway map was first produced with the assistance of a multi-disciplinary ED team. In order to understand trends and variation in patient demand, length of stay and potential CDU appropriateness; detailed analysis of anonymised data recorded on the Trust ED system was undertaken.
The ED clinical and managerial team determined that the criteria for CDU inclusion. A model of the ED pathway was built in Simul8 incorporating the CDU clinical acceptance model and actual data from the whole of 2016.
The results
With a CDU open 24hrs a day 7 days a week, 99.9% of the time 4 cubicles would be adequate.
In a year, just under 2% of attendances would be appropriate to route to the CDU which would have an impact of improving RD&E performance against the 4hr standard by +1.7%.
These results will be integrated into the ED capital programme business case going to the RD&E Board in June 2017.