[ACEM guideline on ED SSUs](x-devonthink-item://DE79145E-48BA-420F-BBB0-8332D43336F6) [ACEM Emergency Department design guidelines](x-devonthink-item://6A0E3FE5-5D2B-42B0-83E4-39092DCE597E) > [!key points] SSU KPIs > - \<15% of patients admitted to ED SSU admitted inpatient > - \<10% of patients have LOS >24 hours > - percentage of pts admitted to ED SSU with combined ED/SSU LOS <4 hours  > - pts with ED SSU LOS <1 hour # ACEM criteria ## inclusion - clinically stable - low-to-moderate risk symptoms - with optimal diagnostic support and clinical management, are expected to be discharged within a 4-24 hour period - have a clear, documented management and disposition plan endorsed by the senior clinical decision maker, which includes planned and ongoing patient reviews, and assessment and reassessment ## exclusion - anticipated duration of treatment > 24 hours - admitted under care of inpatient team - pt been transferred to hospital for admission under care of an inpatient team - clinically unstable - patient has complex care needs, which are unable to be met in the ED SSU - undifferentiated and unclear management plan - +/- SSU depending on available resources: - needing advanced physiological monitoring - needing increased supervision eg behavioural disturbance - assistance in transfers beyond staffing capacity # How do short stay units differ form inpatient wards? 1. Staffed by ED, admission at ED discretion 2. More frequent medical review and ward rounds 3. Strict admission criteria and exclusion criteria 4. Preferential access to radiology and laboratory services 5. High allied health input to facilittae discharge processes 6. High rate of patient turnover # Give some examples of conditions that are appropriate for SSU: 1. Time limited intensive treatment- migraine, gastro, asthma, renal colic 2. Period of observation- post procedure, awaiting investigations, minor head injury 3. Allied health input- elderly patients, not appropriate for after hours discharge 4. Mental health input- calm, co-operative patients awaiting MH assessment # List the exclusion criteria for SSU admission 1. Admission likely to be over 24 hours 2. Complex medical issues, multiple co-morbidities 3. No clear management plan/diagnosis 4. Agitated/violent/aggressive patient 5. High nursing workload- needs 1 on 1 care # What are the potential benefits of having a SSU: 1. Medical- improved patient care, more time for symptom control, avoid hospital admission 2. Social- avoid late night discharges in vulnerable group, avoid unnecessary admissions for social work/allied health input that cannot happen in timely fashion in ED 3. Funding- improve ED funding and therefore care in rest of department/areas 4. Safety- safety net for patients who need observation or time for diagnosis to be made/investigations to be facilitated. # What are some potential hazards of having a SSU? 1. Deferring of decision making 2. Overall increase in admission rate of patients that would have otherwise been discharged 3. Failure to exclude serious diagnoses prior to SSU transfer- increased mortality 4. Access block- patients who 'fail' SSU end up stuck waiting for bed on ward, where priority is given to patients in main department # What are the predictors of failed SSU admission: 1. IP referral prior to SSU transfer 2. Unable to weight bear 3. Multiple medical co-morbidities 4. Social circumstances 5. No response or deterioration despite active treatment in ED 6. More than one active problem # Outline how you plan to reduce the rate of 'failed SSU' admissions: 1. Implement strict admission criteria- e.g. time limited intensive treatment conditions 2. Strict exclusion criteria in place 3. All cases to be discussed with and approved by senior overseeing clinician # other questions - [ED design AFEM 2023.2 Q21](x-devonthink-item://E50B2E75-61B9-43CD-9559-D5EBB0B3E220?page=35)