Modelling the potential impact of having a Clinical Decision Unit at Royal Devon and Exeter hospital


30 Second Summary

A Clinical Decision Unit (CDU) at the Royal Devon & Exeter NHS Foundation Trust (RD&E) would manage ED patients needing up to 12 hours of care. Analysis showed that a 24/7 CDU with 4 cubicles could handle 2% of attendances, improving the 4-hour standard by 1.7%.

Discrete Event Simulation (DES)
Reducing Backlogs
Author
Affiliation

Alaric Moore

Royal Devon University Healthcare NHS Foundation Trust

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.