REDESIGN CDU

Redesign CDU

Redesign CDU

This paper discusses the significant changes to be made to redesign the patient journey in CDU and how would these changes enhance the patient experience and out comes. It is a 50 bed area and comprises over a small High Monitoring Unit, it has 5X6 medical and surgical admission beds and 2x6 short stay patients' beds, plus a chair assessment unit.

Introduction

Influencing nurses to explore evidence that can positively impact on their practice is a significant challenge for any nursing service. Although the value of evidence is widely acknowledged, nurses do not routinely incorporate it into their practice. Many reasons have been cited for this lack of integration into practice; in particular, nurses do not see it as relevant, lack confidence in their ability, do not have time and do not believe the organization will support them to introduce changes. Organizations are increasingly re-examining strategies, leading to some changes in structure and function in order to enhance initiatives pertaining to evidence to improve health-care outcomes(Horrocks, Anderson & Salisbury, 2002, 819-823). A multifaceted approach to innovation in practice is needed to counter strong traditions in nursing practice that serve to limit the potential of evidence in practice.14 Clinical development units (CDUs) have been recognized as an effective strategy to progress creativity and resourcefulness in nursing practice through the facilitation of research utilization and progressive development of staff (Mezey, McGiven& Sullivan, 2003, 63-108)

What is a CDU unit

The Clinical Decision Unit (or CDU as it is known) is a 12 bedded unit based on Ward 38 at the LGI (at present) and within the A&E department at St James University Hospital. The concept of a CDU is to provide an efficient and effective approach to the management of patients with emergent conditions who require specific pathologies to be identified or excluded and have an early likelihood of discharge. It allows patients to be assessed using evidence based strategies, resulting in optimal resource utilisation (Lewis, 1967, 1236-41)The CDU also allows staff in the Emergency Department to minimise the clinical risk in managing certain groups of these patients. The unit provides many different functions under this name depending on the protocol the patient is enrolled in:

Rapid Diagnosis and Treatment Centre (chest pain/pulmonary embolus/SAH).

Observation/treatment ward (asthma/head injury/anaphylaxis).

Ambulatory Medicine (DVT).

The CDU in Leeds General Infirmary opened in January 2001 and after a pilot phase received further funding in March 2001. Another CDU opened in St James's University Hospital soon after. At present the following protocols are running, with potential for further protocols to be added in the future:

Chest pain - to exclude an acute coronary syndrome.

Pulmonary Embolus (PE) - to exclude pulmonary embolism.

DVT.

Renal Colic - to exclude renal calculus/obstruction.

Minor head injury.

Asthma.

Pneumonia.

Cellulitis.

Syncope.

Headache - to exclude SAH (awaited).

Anaphylaxis (awaited).

Pneumothorax (awaited)

At present the majority of patients are entering the Chest pain, DVT and? PE protocols, in the setting of a CDU there is the opportunity to research and devise and evaluate other protocols that could be ...