Emergency measures

New inpatient unit will help expedite care for patients awaiting tests or consults

clinical decision unit
The clinical desicion unit at Health Sciences Centre Winnipeg will help improve wait times in the emergency department.

Winnipeg Health Region
Wave, November / December 2014

The Winnipeg Health Region has launched a new inpatient unit at Health Sciences Centre Winnipeg with a view to improving emergency department flow and reducing wait times.

The six-bed clinical decision unit (CDU) is designed to expedite care for patients who have seen a doctor but are awaiting further action to address their health needs, says Lori Lamont, the Vice President and Chief Nursing Officer with the Region.

As she explains, the emergency department receives patients every day who may or may not require a hospital stay to address medical issues ranging from gastrointestinal disorders to heart-related issues. In some cases, these patients can be assessed quickly and admitted to hospital or sent home. In other cases, though, more time is required to determine the patient's care needs.

"Depending on the findings, they might need surgical intervention, or they might need some treatment and be able to go home," she says.

The problem is that the patients who need more time for assessment end up staying in the emergency department longer than they should, being prepped for tests or waiting for consults and service.

For example, over the course of a six-week period, the Region identified 563 patients who stayed in emergency for an average of 36 hours, but were not admitted to hospital for treatment or care. Overall, those staying longer than 24 hours take up about 13 per cent of the available stretcher space in emergency.

"Currently in our system, many patients have a 24-, 48-, 72-hour stay in our emergency department. That's not a good place for them, and it really puts pressure on our emergency department and prevents us from having space to see new patients," she says.

"The idea of the CDU is to create a small unit where there is dedicated staff providing support for patients with acute care needs requiring further treatment and assessment," says Lamont.

"What we hope it will do is eliminate the number of people who stay for 24 hours or more in the emergency department. And if we do that, it will improve waiting times in the waiting room - possibly by as much as 15 per cent - and reduce the delays in ambulance offloading."

Generally speaking, the CDU will focus on patients who might fall into one of the following categories:

  • Patients who have been medically cleared but are not safe to be discharged without supports or have no home to go to.
  • Selected patients who are stable and require further assessment that may take a day or two.

Lamont says she expects most of the patients transferred to the CDU will end up being discharged once their particular issues are ironed out. "For a small number of people, the investigations will be such that they will need a longer stay in hospital, so they would be transferred to an inpatient bed," she says.

She says research in other jurisdictions suggests that clinical decision units are effective. "Sometimes people think that the clinical decision unit is for social admissions, people who don't actually have an acute or sub-acute medical need. But in fact where they have been most successful is with (patients) who do have an acute care need; it's just not clear whether they really need to be admitted to hospital, or if they do need admission to hospital, what the course of treatment would be."

The inter-professional unit will Your Health doctors, nurses, physiotherapists, occupational therapists and social workers. Based on current figures, the Region expects the CDU to have an average of four patients on the ward each day, with two admissions and two discharges every day. The CDU at HSC is being run as a pilot project. If it proves effective, the concept may be extended to other hospitals in the city.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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