Appropriateness for admission may be determined by EM Consultant discretion, when available (0800-2200).
Please use this reference to determine appropriateness for medical admissions to CDU, in conjunction with EM SpR discussion.
Medical Admission Criteria for CDU
- Ensure patient is likely to discharge within 24 hours
- Completed Kardex
- CDU Referral completed on iCM.
- Haemodynamically stable.
- Low suspicion for acute surgical process.
- Clear period of sustained stability (>1h) prior to admission to CDU, i.e protecting airway and no change in haemodynamics.
- Clear discharge plan in place (waiting for diagnostic or treatment response).
Inappropriate CDU Admissions
- Unstable physiological parameters (e.g. sustained tachycardia)
- Ongoing resuscitation
- Likelihood of operative intervention
- Behaviourally disruptive patients
- Patients judged to be at extreme risk of suicide
- Complex medical problems (e.g. Diabetic Keto-Acidosis, Pyrexia Unknown Origin)
- Elderly patients with mobility issues
- Functional neurologic disorder
- Obstetric and gynaecological cases
- Acute on chronic pain (link below)
Typically Appropriate Medical Conditions
- Deliberate Self Harm/Overdose
- "Rule Out" Subarachnoid Haemorrhage
- Cellulitis
- Intoxication
- Acute Alcohol Withdrawal
- Treated Anaphylaxis
- Renal Colic
- Symptomatic dehydration / mild AKI with clear reversible aetiology
- First Time Seizure
- Spontaneous Pneumothorax
Special Considerations
Renal Colic / Flank Pain
- Remember that patients with abdominal or flank pain can have other serious pathologies.
- A CT KUB will not routinely discover other aetiologies of pain.
- If this could be an aortic emergency or intra-abdominal process, CT angiogram of aorta or CT abdomen/pelvis with contrast are most appropriate studies.
- Do not admit a patient to CDU if there is any concern for aortic emergency or a surgical intra-abdominal process.
Abdominal Pain in CDU
- If a patient is haemodynamically stable and has abdominal pain without a surgical abdomen and with low suspicion for acute surgical process/aortic emergency, awaiting CT A/P to determine medical v surgical aetiology, this patient may be appropriate for CDU (eg. suspicion for colitis, with a plan to discharge after imaging without medical/surgical team involvement if CT uncomplicated).
- In other words, if the most likely working diagnosis is appropriate for EM management but a lower-likelihood (high risk) diagnosis needs excluding prior to discharge.
- High suspicion for surgical process is inappropriate for CDU.
Back Pain in CDU
- Patients with this condition often exceed 24h admission.
- Limit back pain admissions to those patients with back pain red flags who require in-person review by neurosurgery (not able to be provided in the ED) and/or MRI to r/o neurosurgical emergency.
- Pain that does not improve sufficiently for discharge during the initial phase of ED care is also unlikely to improve sufficiently within 24h and therefore likely needs a medical admission.
- For treatment of chronic back pain without red flags and with no neurologic findings (if there is no expected neurosurgical intervention) the patient should either be discharged, or admitted to medical team, for e.g if unable to mobilise/manage at home (i.e requires inpatient pain control and therapies for functional limitations of pain).
Expanded Medical Admission Criteria
Self Harm/Overdose
The EM provider requesting CDU admission for these patients is responsible for ensuring an appropriately safe environment is available to these patients in the CDU. For example, a patient should not have access to any potentially harmful substances (e.g a supply of their own medications, particularly in cases of recent overdose). This is particularly important for overnight admissions.
For further information see Assessment post DSH
Cellulitis
This condition is commonly associated with prolonged CDU stays, please consider if more appropriate for medical admission based on comorbidities such as diabetes, peripheral vascular disease, lymphedema. Pain out of proportion to exam findings should raise concern for necrotising fasciitis and is not appropriate for CDU. Cellulitis with undrained abscess is not appropriate for CDU.
For further information see Cellulitis
Intoxication
Patients with any concern for airway patency (eg apneic events/sonorous respirations), inadequate airway protection (e.g absence of gag reflex/tolerating a nasal airway) or inability to follow commands, are not appropriate for CDU. A patient should be able to clear secretions on command: “cough for me” and maintain a safely positioned airway independently.
Patients should be seen to be consistently stable in terms of these airway parameters, in addition to haemodynamically, for at least one hour in the main ED before consideration given to CDU admission.
Treated Anaphylaxis
Most cases of anaphylaxis will not require CDU admission. If a patient has persistent/protracted/refractory anaphylaxis they are more appropriate for medical/ICU admission.
Patients appropriate for CDU are those who are successfully treated (symptoms largely resolved) but deemed to be high risk for recurrence (i.e biphasic reaction) due to severe initial presentation, delayed time to first epinephrine treatment (eg, >60 minutes), need for >1 dose of epinephrine, unknown trigger, prolonged interval from trigger to start of sx, possible ongoing exposure to trigger (e.g sustained release medication), OR if there is a concerning social circumstance such as long commute home, living alone, etc.
For further information see Anaphylaxis