The Guide For CDU SHOs

What is CDU? CDU is the Emergency Department’s inpatient ward. The aim is to deliver intensive short term

assessment, observation, therapy and discharge for a selected group of patients. Ultimately, we want to

prevent unnecessary lengthy admissions under a specialty.

It is to be used only for STABLE patients who:

- Meet the admission criteria for one of the 16 pathways (see CDU proforma)

- Are expected to be discharged in ≤ 24 hours (longer than this timeframe will require referral to

appropriate specialty)

Discharge Lounge vs. CDU:

If patients are medically fit for discharge and awaiting transport, they can be sent straight to discharge

lounge. They will need a drug chart to take with them.

The Role of the CDU SHO The day is split into 3 shifts:

1. 08:00 – 17:00 (day)

2. 16:00 – 24:00 (twilight)

3. 21:00 – 08:30 (night)

08:00- 17:00

- Expected to stay in CDU throughout the shift

- 08:00 - 09:00

o Handover to occur between the night SHO, day SHO AND an ED consultant.

o Following handover, the SHO is expected to go through the patients’ notes in CDU to

prepare for the MDT Board Round at 9am. This includes:

� Chasing any outstanding jobs

� Checking blood or scan results

� Ensuring drug charts and VTE assessments are up to date for each patient

� Checking the latest care plans documented by physiotherapists/occupational

therapists (if applicable)

- 09:00

o MDT Board Round. Present: nurse in charge for CDU, physiotherapist, occupational

therapist, psychiatric liaison, deputy nurse in charge, CDU SHO and CDU consultant. All to

meet in ED staff room and go through each patient’s up to date care plan.

- After the board round, SHO starts the ward round with CDU Consultant.

- Throughout the day, the SHO is to review all new admissions, including documentation /

treatment plan and complete VTEs, drug charts, and ensure patient is admitted on PTS.

- Take referrals from shop floor via bleep 343 or face to face

- Paediatric MSU booklet

o The CDU SHO is expected to check children’s MSU/other specimen results on APEX every

day

o The pink folder that holds this information is kept in the ED Paediatrics cupboard (ask a

Paediatric nurse and she can help you locate this).

o If a result is positive, discuss it with senior re: management. The patient will need to be

contacted and management initiated.

o If a result is a notifiable disease, it must be reported to the local group. A form specifically

for this is found on the intranet under ED guidelines. Print a copy off, fill in the relevant

details, and give it to the ward clerk in the shop floor to post it. Call the GP immediately

to inform them of the result.

16:00 – 24:00

- Handover at 16:00 to occur between day SHO, twilight SHO and ED consultant present

- Review all new admissions, including documentation / treatment plan and complete VTEs, drug

charts, and ensure patient is admitted on PTS

- Attend CDU if needed

- Take referrals from shop floor via bleep 343 or face to face

21:00 – 08:30

- Handover at 23:00 to occur between twilight SHO, night SHO and ED consultant/night registrar

- SHO is based on shop-floor, and attends ward for new admissions, complete VTE/ drug chart,

ensures patient admission on PTS

- Take referrals from shop floor via bleep 343 or face to face

- Note: not many discharges happen overnight, however suitable patients should be reviewed and

discharged at any time.

****During 16:00 – 24:00 and 21:00 – 08:30, the CDU SHO’s priority is clerking patients

on the shop floor. We understand during busy times it can be difficult doing this AND

looking after patients on CDU. Please aim to see any new patient within one hour of

admission to CDU. This will ensure any outstanding jobs can be dealt with sooner, which

could potentially lead to a sooner discharge****

New Admissions

Role of CDU SHO

The CDU SHO is responsible for:

o Completion of drug charts, VTE assessments and ensuring admission onto PTS for every

patient

o Timely review of awaited investigations or treatments

o Timely discharge of patient

o Re-discussion with ED senior if there is a change in the patient’s condition

The ED Clerking doctor should at all times:

o Discuss admission to CDU with senior doctor in charge, nurse in charge and complete

admission pro-forma (nurse handing over patient and CDU nurse should double check

this).

o Refer patient to CDU SHO via bleep 343 or face to face and provide all necessary

information, treatment and long term follow up plans after discharge

o Organize and book long term follow up (fracture clinic, etc.)

o Organize and document repeat investigations needed according to plan (blood test,

OT/PT, psych referral letter etc.)

The Nurse in Charge and CDU SHO MUST be informed of every transfer BEFORE

the patient is physically transferred to CDU. CDU SHO must contact ED senior in charge if finds an

admission outside guidelines.

Handover - Handover between SHOs must take place with consultant/senior SpR

- Handover times: 08:00, 16:00, 23:00 – leaves one hour for SHO stepping down to sort out loose

ends

CDU Team and Contact Details

CDU Team

Bleep Ext

Consultant (after midnight senior SpR) 552

SHO 343 6978

PT 559

OT 935

Pharmacist 543 1681

CDU Nurse and HCA 6978

Nurse in Charge 1900

Patient Flow Coordinator 1900

Discharges

- CDU SHO to inform patient flow coordinator / NIC when patient is discharged.

- All complicated discharges should be discussed with Senior.

Patient Tracking System (PTS)

All discharges from CDU should have a PTS discharge letter.

1. Login to PTS with computer/PTS login – call IT if you do not know this information (Ext: 1717)

2. Select New EDS.

3. Enter patient MRN number. This should bring up patient details. Click on MRN number to open

new EDS.

4. Complete discharge details page:

• Patient details are typically automatically filled, including GP details.

• All starred boxes are required details

o Ward (ED OBS)

o Speciality (Accident and Emergency)

o Often you are able to copy and paste ED clerking from firstnet into clinical details box

and edit/add information as required.

o The EDS is automatically signed by doctor logging into PTS.

5. Allergies/Medication Tab (i.e. TTOs)

• If making no changes to regular medications, it is acceptable to write this in the ‘Allergies,

risks and warnings’ box.

• Select ‘Ready for Pharmacy Screen’ and one of the options below this; typically it will be the

first option ‘Medications have been explained to patient or carer…’

*** If pharmacy input is required, CDU pharmacist should be contacted at this point ***

• Select Save details; a box may appear with your name and bleep - select ok to close this.

• The EDS is now saved and is ready to be screened by pharmacy.

• If you require NO pharmacy input, click the tab at the top “Screen Meds”.

• Then select ‘No pharmacy input required ‘ (top left on Allergies/Medication Tab) and save

details once again.

• Once the TTO is complete, select the “Finalise” tab (please note you can not amend the

EDS after finalising).

• One copy should be given to the patient and the other copy should be sent to the GP.

• If the facility is available, the GP copy will be transferred electronically, and if this is not possible, a

print out of this letter should be placed into the patient’s notes with a memo for the ward clerk to

post to GP.

If pharmacy input is needed (i.e. pt is being discharged to community bed/new medications)

• The TTO details must be filled in, and pharmacy should be bleeped/called to inform them the

TTO requires screening.

• If patients are being discharged to rehabilitation beds/community hospital, 14 days TTOs and a

printed copy of the MAR chart are required (available from PTS after finalisation).

• If being started on new medication, a boots prescription can be completed (if within opening

hours) for acute medication e.g. antibiotics/analgesia.