Truly an opportunity to be welcomed.....but as JP
says, the definition is paramount annd it is about
more than names.
It sounds like you are talking about a unit with beds,
ie a ward, where patients being admitted under the
physicians are placed before transfer to definitive
wards. Allows the take physicians to see their post
take ward round pts quickly. I call this a 'take
We have had our own directorate and an emergency
assessment unit as part of the ED here in Bath for 6
years (set up by David Watson): trolleys not beds,
takes all the low acuity GP referrals to the medical
and surgical teams. Our computer system, our nurses,
and we provide alternative supervision to minimise
'green venflon resuscitation'.
Closes at night with all patients moving off into
their definitive bed as soon as all admission
investigations done and clerked, etc.
Also allows decant of low acuity pt from ED but not
used for 'storing' ED patients awaiting a bed
Unfortunately the above system only works as described
when the hospital has enough beds: in times of crisis,
it simply becomes another medical ward - even with
trolleys! If the ED is to run it, I would strongly
suggest you have trolleys not beds, though with the 4h
trolley wait time coming in I suspect managers may not
agree to this.
It will give you a powerful voice to speak for the
> the patients are looked after mainly by Medical
> SHO's - one of the problems has been lack of senior
> input on the unit.
make sure you get 24h middle grade full shift cover
then - and another consultant if poss! Keep sick
patients in the main dept.
> I am particularly interested into the input from the
> Physicians - do the Medical Consultants still do
> ward rounds on the unit?
yes when patients havent moved off to wards due to bed
block, not otherwise
> is day to day care
> provided by Medical Juniors or A&E docs?
medical and surg SHOs
> what is the level of clinical input from the A&E
becuase it is staffed by ED nurses, they call us on
the tannoy if they are worried aboutr anyone... we
tend to walk through there regularly to 'sniff out
trouble' but don't get involved routinely. I speak to
the new HOs and SHOs for the hosp every six months and
ask them to use us for support, and they do
> Do the units have a maximum stay prior
> to discharge or admission to a Medical Ward? - if
> so, how long - 24 hrs, 48hrs ...?
yes, should close every night but max stay is
meaningless if hosp too small
How do you prevent
> the "bottleneck" moving from the A&E/EAU interface
> to the EAU/Medical ward interface?
There's no difference - and ofr course we are at the
mercy of the hospitals bed state. Runnning the bed
bureau is awesome but may help....though if you are
running everything then you have fewer people to blame
when things dont work
I would like to
> incorporate a Clinical Decision Unit into the new
> EAU [emphasis on assessment not admission] - is this
Never liked the term CDU. Aren't our whole departments
one big clinical decision unit? You can set up an
observation facility to house people on whom you are
doing rule - out strategies: 'top tip' on that one is
to make sure it is geographically part of your unit
and long stay comfy trolley based to prevent it
becoming medical overflow (ours isnt....yet).
I suggest you go on tour and look at a few places -
our set up is far from perfect - sure there's better -
but youre welcome
--- Richard BAILEY <[log in to unmask]>
> Dear List
> I would welcome any pearls of wisdom/advice from any
> A&E docs out there who have experience of managing
> EAU. Our trust is about to create a new directorate
> [Emergency Care Directorate] which will include A&E,
> EAU and the bed bureau. It is almost tied on that
> the Clinical Director will be from A&E. EAU
> presently is "managed" by the Medical Directorate
> I think this is a fantastic opportunity for us to
> really move things forward but recognise there are
> many pitfalls and potential problems - all
> constructive help will be welcome!
> Best wishes
> Bill Bailey, A&E Chesterfield
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