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St James' ED General Management
The Clinical Decisions Unit (CDU) at present is near the ambulance entrance but is run by A&E. The aim of the unit is to assess, observe, and rapidly investigate certain patients in whom there is diagnostic uncertainty and where an answer can be provided within 6-24 hours. Other patients may require observation and some treatment alone. There are specific protocols for a variety of conditions. Entry to the unit is after review by, or discussion with, the CDU doctor and nurses although some protocols are nurse driven (see appendix 2 for processing of CDU patients). Copies of the protocols are available from the EMIBank. Hard copies are available in CDU.
The protocols are:
1. Rapid diagnostics and decision-making
- ?Cardiac chest pain ?MI – low risk (normal or non diagnostic ECG)
- ? Pulmonary embolus – low or intermediate risk and some high-risk patients.
- ?Deep venous thrombosis
- ?Renal colic
- ?Sub-Arachnoid haemorrhage
2. Observation and re-assessment / out patient referral
- Syncope ? Cause
- Minor head injury
- TIAs
- Pneumothorax
- Minor upper GI bleeding
- Deliberate self harm (done on Ward 1)
- Abdominal Pain
3. Treatment and rapid discharge
- Cellulitis
- Mild asthma
- Pneumonia with likelihood of discharge within 24hrs
- Anaphylaxis