Combined Assessment Unit (CAU) / Acute Medical Unit (AMU)
The Combined Assessment Unit is located beside the Emergency Department, and functions as the ‘front door’ of the hospital for patients with acute medical problems. People are referred to the CAU either by their GP, by the Emergency Department, by the Out of Hours GP service, or occasionally from an outpatient clinic. The CAU’s role is to perform initial assessment, investigation, and treatment, and to agree a management plan with the patient. Some patients are then able to go home the same day, while others require admission to the CAU inpatient beds or to the downstream medical wards.
How long do patients stay in the CAU?
This depends on what treatment is required. Typically, 9 out of 10 people spend less than 48 hours in the unit.
3 in 10 people go home directly from the Combined Assessment Unit within 24 hours
1 in 10 people go home directly from the Combined Assessment Unit after a slightly longer stay
6 in 10 people require ongoing care elsewhere in the hospital.
What happens to a patient referred into CAU?
The CAU is split into 3 main areas:
- The Triage area
- The Assessment Area (pictured)
- Short stay beds (Pods B, C and D)
The Unit’s layout and flow changes with updates to infection control and government guidance during the COVID-19 pandemic.
In general when a patient arrives, they are directed to either the Triage or Assessment areas dependent on the reason for referral and any infection concerns. The nursing staff will check basic observations (pulse, blood pressure, breathing, and temperature). Investigations such as a heart tracing (ECG), X-rays, scans and blood tests may be performed or ordered. The next step is a more detailed assessment by a Advanced Nurse Practitioner or Doctor. Some patients who are sufficiently well and who do not pose an infection risk may be asked to sit in the waiting area between assessments in order to maintain space for others. All patients are then reviewed by a consultant (within a few hours for patients who arrive during the day, and on the next morning’s ward round for those who arrive overnight).
Patients who are expected to go home within 24-36 hours after investigations and/or treatment generally remain on the CAU in one of the Pod beds. Patients who may require a longer inpatient stay will move to a downstream specialty bed when it becomes available. All patients have a daily medical review for the duration of their stay in CAU, including at weekends.
A hot drinks trolley goes round the unit several times a day, and free newspapers are provided in the mornings.
All the Pod bedrooms have private bathrooms and televisions.
Ambulatory Emergency Care
Some patients may (after initial assessment and usually consultant review / advice) be well enough to go home to return the following day for arranged further scans or tests that cannot be performed on the day of initial arrival. This is called ‘Ambulatory Emergency Care’. We need to make sure you are well enough to be appropriate for this and will discuss this with you if it is an option.
Who is in the CAU Team?
- Nursing staff
- Advanced Nurse Practitioners
- Junior and Middle Grade doctors
- Occupational Therapists
- Social Work
- Frailty Team
- Students from all of the above professions
Referrals can also be made to Speech and Language Therapy, Dietetics, and specialty medical teams as required.
Useful items to bring to the CAU:
- Patient’s own medications
- Book or tablet computer (it can take several hours to complete assessment).
- Phone charger
Are visitors allowed in the CAU?
Dumfries and Galloway Royal Infirmary is following Scottish Government Guidance on hospital visiting, the most up-to-date guidance being found at https://www.gov.scot/publications/coronavirus-covid-19-hospital-visiting-guidance/. This will change over time so please check for the current policy. Please be aware this Unit will be assessing patients with possible COVID, advice on how visiting is affected is also found on the government’s webpage [last accessed 31/5/21].
We will do our utmost to keep relatives up to date with what is happening, and members of our team may also phone families as part of the assessment process or to help with discharge planning.
How to get information on relatives’ care:
Nursing staff are the first port of call for updates. Relatives may also ask to speak to a junior doctor if further detail or discussion is needed. Consultants can be contacted via the Nurse in Charge or via their secretaries, and appointments can be made for phone conversations if they are not immediately available. We encourage patients and relatives to approach us if you have questions or concerns – it is important to us that people feel informed and up to date with what is going on, especially when visiting is limited.
On the day of discharge, we aim to identify possible discharges in the morning, and make contact with appropriate family, carer and/or ambulance staff to arrange details. If there are changes to a patient’s medication, there is usually a wait for the letter to be completed and medicines to come from pharmacy. This can take a few hours, so please be patient while we get things ready. If no changes have been made to medication, patients may leave immediately and we will post a discharge letter out to them.
Our goal is to provide high quality, patient-centred care and ensure patients and their families feel safe in our hands during a stressful time. Please feel free to approach us with any questions or concerns.