Welcome to Acute Assessment Unit & Clinical Assessment Unit
AAU & CAU are the medical and ambulatory receiving units respectively. The acute medical unit is made up of the Clinical Assessment Unit (CAU) and the Acute Assessment Units 1, 2 and 3.
Clinical Assessment Unit (CAU)
The clinical assessment unit is made up of 16 beds and a chaired area for ambulant patients and those waiting to be seen. The aim is for patients only to remain in the unit for a maximum of 12-16hours; these patients should largely be managed as outpatients or have short admission only.
Acute Assessment Unit (AAU1/2)
AAU1/2 is made up of 46 beds. Patients are referred to AAU from the community via General Practice/Out of Hours and also from the Emergency Department. Occasionally patients are also referred from clinic, the renal unit and other areas of the hospital. These patients are expected to need inpatient hospital admission.
Acute Assessment Unit 3 (AAU 3)
AAU-3 is made up 8 beds on the other side of the Emergency Department. These patients have previously seen in AAU 1/2/CAU and are likely to be discharged within in 24 hours. AAU-3 also occasionally has Head Injury patients from the Emergency Department who remain under the care of the Emergency Department.
Key Contacts
- Ann McKean – Senior Charge Nurse
- Lisa Fabisak – Lead ANP
- Dr Catherine Maclean – Clinical Lead
Day to Day
The below information pertains to the ‘medical take’ and assessment/responsibility for new patients being admitted to hospital. The process for ambulant patients is slightly different and outlined in the CAU section.
Ward round structure
The unit is split into 3 ‘pods’ which are each looked after by a consultant supported by FY1 or NP for ward round support and a cohort of ANPs/middle grade doctors to clerk new patients.
Pod 1 (Beds 1-7, 11-17, 37-46) – Ageing & Health consultant (0800-2030), with predominantly frail patients. The frailty CDF will also work within this pod for post post-take reviews or clerking.
Pod 2 (Beds 8-10, 18-36) – General medical consultant (0800-2030), with predominantly non-frail patients. Post post-take reviews maybe carried out by the on-call team or one of the CAU middle grade doctors (rota dependant).
Pod 3 (CAU/Ambulatory care) – Acute physician (0800-1630) then backshift consultant (1430-2030). The acute physician will be supported by an FY1 0800-1630 and the backshift consultant by an NP. CAU middle grades/ANPs will facilitate clerking of new patients and post post-take reviews.
- The consultant ownership of each patient in AAU/CAU is clarified at the twice daily board and updated on Trakcare.
- You must ensure that the consultant ownership is correct on the IDL when discharging a patient (to allow consultants to track discharges and ensure that results are not missed)
- There are ward round computers that are marked for specific ward rounds and stored next to AAU2. Please ensure that the computers are returned and plugged into charge when not in use.
Roles and Responsibilities
A daily rota is placed in the MDT room detailing who is attached to each team. This is updated the evening before by the ANP/NPs.
FY1 Role
- Attend AAU handover at 8am & 8pm and safety huddle at 14:15.
- Either FY1s or NPs will update Trakcare with consultant ownership during handover
- Provide support on ward rounds and ensure the consultant plan is carried out efficiently
- Request investigations, review results and ensure treatment carried out promptly. This includes requesting bloods for the following day if clinically indicated
- Keep the board up to date (in CAU and AAU)
- Update Trakcare when consultant review complete
- Expedite patient discharges
- Respond to NEWS ≥ 5 triggering or unwell patients within CAU/AAU under care of your attached consultant
- Ensure immediate discharge letters (IDLs) are complete and released
- The ‘late/back shift’ role allows for further experience in clerking with the opportunity to clerk emergency referrals
- The CAU FY1 supports the acute physician ward round – this person should also collect all requests in the AAU MDT room and deliver to the relevant departments
- Contribute to cardiac arrest team (AAU FY1s, not CAU FY1), including attending the huddle in CAU MDT room after handover
ANP Role (Bleep 1001/1008)
- Co-ordinate FY1 & NP staff to meet the needs of the service
- Know of high risk patients clinically and otherwise & help identify potential Ambulatory Emergency Care (AEC) patients
- Review patients on telemetry and update telemetry board (removing those patients who no longer meet the telemetry criteria)
- Work with the CAU acute physician and the on-call physician/geriatrician, to deliver Ambulatory Emergency Care in CAU. Support staff to review patients in the AEC area, including AEC returns.
- Lead CAU cardiac arrest huddle
- Work alongside CAU middle grade doctors to assessment, manage and discharge ambulatory patients
- Coordinate, in conjunction with CAU middle grades, assessment of patients returning for investigation or DVT assessment
NP Role
- Attend AAU handover at 8am & 8pm and huddle at 1415. Either the FY1 or NP will update Trakcare during handover with appropriate consultant.
- Primary role is to support the ward round and carry out any pre and post ward round duties as required, including requesting and reviewing investigations and writing IDLs
- Expedite investigations and treatment to ensure length of stay is reduced to a minimum
- Provide support to nursing staff and medical staff in the care of unwell patients.
- Promote the use of checklists and bundles
- Provide leadership in compliance with clinical initiatives
- Each NP is involved in an area of audit to promote best practice and compliance with patient safety initiatives
- Contribute to cardiac arrest team
On-call middle grade role (bleep 1857)
- Attend 8am and 8pm AAU/CAU handovers and huddle at 14:15.
- First point of contact for patients triggering NEWS ≥ 7 and patients with possible neutropenic sepsis
- Ensure that deteriorating patient checklists and sepsis 6 bundle stickers are completed reliably
- Clerk patients in AAU, with flexibility to move through to CAU if the balance of workload requires it
- Present patients on post-take ward rounds where possible
- Carry out procedures within the assessment unit including LP, ascitic drain, chest drain or vascular access (supervised as appropriate)
- Support FY1/NPs with management of sick patients or complex family discussions
Medical registrar role (bleep 1245)
- Attend 8am & 8pm AAU handovers in AAU MDT room
- Attend cardiac arrest huddle at 0830 in CAU and lead medical emergency/arrest team
- Daily AAU work involves assessing and managing patients across AAU/CAU and coordinating/ supervising the medical team
- In the evening it tends to be busy and there are 2 middle grades on for the wards (long days 8am-8.30pm) who can be paged to come and help if able
- The call handler manager receives the GP/ED referrals. Patients in resus or triggering NEWS ≥ 7 will also be referred directly to the medical registrar by the referring team
- Requests for medical reviews out of hours come to the medical registrar
- Out of specialty reviews for surgical wards are done by the day medicine SHO until 5pm
Typical Staffing
Staffing within the assessment unit varies depending on clinical need and day of week, but usually will consist of an on-call team plus a CAU based team:
- On-call – Med Reg, SHO, 2 Consultant Physicians, 1 Consultant Geriatrician, 3 FY1s & 2 NPs
- CAU – 2 Middle grade doctors, 1 Acute Physician, 2 ANPs, 1 FY1
AAU and CAU are also supported by a frailty team consisting of a frailty assessment nurse who will screen new patients for CGA and then action immediate needs including collateral history. There is a front door frailty clinical development fellow who will see a proportion of new geriatric patients under supervision of the on-call geriatrician.
Clinical Assessment Unit
CAU is staffed by 2-3 middle grade doctors and NP/ANPs who work in conjunction with the acute physician to manage new ambulatory referrals from ED, GP or outpatient clinics. These patients should generally be discharged same day or next day after assessment, investigation and management.
The CAU team is not ‘on-call’ and work in the unit Mon-Fri 9-5, with exception of ANPs who work full 8-8.30 shift pattern to ensure flow, leadership and coordination of cardiac arrest huddle.
During the day most patients in CAU will be seen and discharged by the CAU team, however those who need admission will be taken over by the receiving medical teams and after 5pm the on-call team cover both AAU and CAU with the help of an additional backshift consultant and middle grade doctor.
Ambulatory patients may be brought back to the unit next day for imaging, procedures or repeat laboratory tests. Typical presentations include:
- DVT
- Papilloedema
- CTPA/?PE
- AF Pathway from ED
- Cancer treatment helpline referrals
Education
Formal teaching takes place every Thursday at 12pm in CAU meeting room, all invited to attend. One of the middle grade or FY1 doctors lead the session based on the ‘A-Z of Acute Medicine’, selecting a topic of choice to present.
FY1/2 doctors are released for protected teaching every week as part of foundation programme.
Other Opportunities:
- Lots of procedures including LP, chest drain and ascitic drain
- Quality improvement work is commonplace and encouraged
- Attendance at management meetings for CAU middle grades
- Cardiac arrest involvement
- Monthly in-situ simulation sessions
- Safety meeting with all staff every Friday at 12pm
- Weekly ‘Fika Friday’ – tea, coffee and cake with colleagues in CAU meeting room at 11.30am
- ACAT/Portfolio completion encouraged, system in place to formalise feedback process for trainees
Additional Info
The assessment unit is a complex, busy system which often bears the pressure from the rest of the hospital at peak times of year. Given the unpredictable nature of this area of the hospital processes and protocols are frequently updated – a fuller, current guide to AAU/CAU is available on intranet/V drive.