Some hospitals have High Dependency Units (HDUs), also called step-down, progressive and intermediate care units. HDUs are wards for people who need more intensive observation, treatment and nursing care than is possible in a general ward but slightly less than that given in intensive care. The ratio of nurses to patients may be slightly lower than in intensive care but higher than in most general wards. Some hospitals have a combined ICU and HDU or a certain number of beds in ICU given to HDU patients. In these cases, although a person is not moved to another ward, the level of care is slightly reduced as s/he is no longer in such a critical state. People spend varying lengths of time in HDU, depending on the nature of their illness and the demands on the unit. Some hospitals in the UK have no HDUs, and in these cases people are usually transferred directly from intensive care to a general ward.
“Before a patient is discharged from intensive care, s/he should have another health check (called a short clinical assessment) to identify:
Any physical or psychological problems
The likelihood of any problems developing in the future, and
Their current rehabilitation needs
An HDU is a specially staffed and equipped area of a hospital that provides a level of care intermediate between intensive care and the general ward care. Although HDUs may be located in or near specialty wards, increasingly they are located within or immediately adjacent to an ICU complex and are often staffed by the ICU.
The HDU provides invasive monitoring and support for patients with or at risk of developing acute (or acute-on-chronic) single-organ failure, particularly where the predicted risk of clinical deterioration is high or unknown. It may act as a ‘step-up’ or ‘step-down’ unit between the level of care delivered on a general ward and that in an ICU. Equipment should be available to manage short-term emergencies (e.g. need for mechanical ventilation). Earlier studies have shown conflicting results about benefits to outcome associated with the introduction of HDUs,8 whereas a more recent survey where HDU care was based on a ‘single-organ failure and support model’ has shown that HDUs play a crucial role in management.
COLORECTAL PATIENTS AND HIGH-DEPENDENCY CARE: EVOLUTION OF THE SURGICAL HIGH-DEPENDENCY UNIT
Traditional postoperative care for abdominal procedures in colorectal patients has been provided by either general ward care or by ITU provision. Two separate observations have identified the need for care provision intermediate between these two levels. First, that within the workload of a general ITU it has become apparent that a significant population is at relatively low risk and might be cared for in an intermediate facility. Thus, Kilpatrick et al (1994) found that among 1168 ITU admissions, 40% of patients were admitted with a risk of hospital mortality of 10% or less: such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. The authors (Kilpatrick et al, 1994) proposed that a group of patients with a low predicted (and actual) mortality rate might be more appropriately managed on a high-dependency unit. Second, it has become apparent from a surgical perspective that continuous monitoring of some patients is required in a unit that provides a specified increased patient to nurse ratio: a surgical high-dependency unit (HDU)
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