To Assign yourself as the provider caring for the patient, please right click the patient on the trackboard and choose "Treatment Team"

In the next prompt, please click the "Add Me" button to add yourself.  PAs/NPs should click the "Team Member" button, MD/DOs should use the "Attending" button.  For NP/PA providers, at this time you should also add the CDU supervising attending (0900-1800 shift) as the "Attending".

Open the CDU Signout Webpage

Open the "CDU Signout Sheet" On a Browser Tab - link: CDU Signout sheet 

Huddle with Nursing Staff

Take a moment to ask each of the nurses in the CDU for a brief signout (from their perspective) on each of their patients. 

• Deal with any urgent issues identified by the nurses on each patient

• If there are any patients not yet listed on the signout sheet, take a moment to add them now

Pre-Round on every patient in the CDU

Take a few minutes for each patient in the CDU to review their chart and progress so far in the CDU. Take note of the following for each patient

• Diagnosis and Pathway in the CDU

• Has the Admit Note been done yet

• Has a Medication Reconciliation been done yet

• Are appropriate orders for their pathway in the CDU entered

• Trend of Vitals, lab results, and medications given for their protocol

• Pending treatments and reassesments needed in the CDU

• Criteria or any Barriers to Discharge

After you have collected this data, please visit every patient at the bedside and assess their clinical status

Round with the CDU Supervising Physician

• With the Data you collected on the last step, please go to the main zone and find the CDU Supervising physician (the 0900 - 1800 shift). 

• Give a brief presentation of each patient to the attending and discuss any problems you have identified.

• Come up with a plan for each patient

• For most patients it is sufficient to do these rounds at a workstation, however, if you are worried about a patient, or are unsure of next steps, the attending should see the patient at the bedside with you. 

Complete CDU Admit notes for all patients

• Check if the patient has a CDU admit note from the previous day

• If there is no CDU admit note, you need to write one

• Please follow the tutorial for Admit to CDU and use the ".iescduadmitnote" dot phase to write this note.

Check that Admission Medication Reconciliation is completed for all patients

• Patients admitted to CDU outside of CDU provider hours likely have not had a Medication Reconciliation completed

• Please complete this important task, refer to the seperate tutorial CDU Admit Med Rec 

Run the list with Care Management

• Find your Care Managers - they will usually be stationed in the back of the CDU, across from Rooms 5 and 6

• Run through your patient list with them to identify any patients with care management needs and come up with a plan

Execute Plans for each patient 

• Execute the plan discussed with the CDU supervising attending

• Most patients should be either discharged or admitted to the hospital during your shift

• Any patients that will stay in CDU past your shift will need a brief progress note describing the plan and progress that day

Disposition Patients from CDU 

• Based on plan established earlier in day, make a decision to discharge or admit most of the patients in the CDU.  

• If you are discharging a patient - including home, the street, a shelter, a SNF, Hospice or a Long Term Care facility, please refer to the separate tutorial on How to Discharge from CDU 

• If you are admitting a patient (or transferring them to another Acute Care Hospital), please follow the steps you would for any ED Patient:

  • Call admitting team (here or at accepting institution) through First Call

  • When they have agreed on the admission, please click "Admitted" or "Transferred to another facility" and Enter the accepting attendings' name

  • Create a progress note using the SmartPhrase ".iescduprogressnote" to document the decision making to admit and transition of care. 

Admit new patients to CDU as they are presented  

• During your shift, there will be new admissions to CDU

• Please refer to the seperate tutorial on How to Admit to CDU 

Write Progress Note on any patient who will stay 

• For any patient who will be staying past your shift, please complete a brief progress note summarizing the current plan, progress and disposition criteria

• Use the template ".iescduprogressnote" to complete this documentation 

• If a patient was admitted during your shift, the CDU admit note is sufficient and a seperate progress note is not necessary unless the plan has changed. 

Run the list / update progress with Supervising Attending  

• In the mid to late afternoon (1600 ish) please touch base with the supervising attending

• Review any new admissions to CDU

• Review progress and plans for each patient and identify any new issues or barriers to disposition

Review Lab Results in ED Inbox

• Please see this separate guide on how to complete SJH ED results inbox

Update the Signout Sheet

• Update the signout sheet so it reflects the unit at the end of your shift 

Sign out the unit to the Cross Cover attending at the end of your Shift

• Please see this guide for completing signout at the end of your day

• Before leaving the building, find the cross cover attending (1800-0300 shift) and give a brief one-line statement for each patient 

• If there are any labs or studies that are expected to result during cross-cover hours, please be sure these are indicated on the signout sheet in the "pending" column and communicated to the cross cover attending.