With demand for inpatient services increasing, Children’s Hospital of Richmond at VCU (CHoR) opened a Pediatric Clinical Decision Unit (CDU) near the hospital’s emergency room this spring with four beds dedicated to patients who require shorter-term observation and care. The opening of this unit is supported by the fact that between 2013 and 2016, nearly half of the children admitted to the general pediatric service at CHoR stayed for less than one day.

When patients require ongoing treatment after an evaluation in CHoR’s emergency room, emergency medicine providers can admit them to the inpatient unit or transition them to the Pediatric CDU, where care is managed by advanced practice practitioners in collaboration with CHoR’s hospital medicine specialists. The Pediatric CDU team consults with other CHoR specialists as needed and follows up with primary care physicians regarding treatment and discharge plans.
 

“Clinical decision units are popular in adult facilities, and more pediatric centers are revisiting these units,” said David E. Marcello III, MD, FAAP, Associate Professor and Chief, Hospital Medicine. “It is a resource for our patients and allows them to receive the care they need and return home as efficiently as possible.”

Patients with conditions ranging from respiratory, infectious and gastrointestinal issues to mild head injuries can be observed and treated in the Pediatric CDU. Treatment can involve observation and evaluation or include short-term intravenous fluids or antibiotics. Patients requiring more than 23 hours of care are transferred to CHoR’s inpatient unit. At this time, patients must be seen in CHoR’s emergency room before being transitioned to the Pediatric CDU.

Dr. Marcello is one of seven hospital medicine specialists who coordinate general pediatric care for CHoR’s inpatients. Because they do not have outpatient responsibilities, hospital medicine physicians are able to focus on inpatient needs and coordinate care by other specialists as warranted. They also lead inpatient education for residents and medical students and collaborate with community pediatricians. Thanks to funding from Children’s Hospital Foundation, CHoR has the only pediatric hospital medicine fellowship program in Virginia and will accept its second fellow this summer.