What Is a High-Dependency Unit?
HDU, or high-dependency unit, is a specialist hospital unit exclusively for patients requiring intensive monitoring and treatment, but not up to the extremity of the critical patients in an ICU. HDU provides more extreme nursing care to the patients than the general ward. It will be an entirely separate department or a ward and is usually set up near an intensive care unit (ICU). High-dependency unit is also considered a transition area between ICU and general ward admission. Patients may be given a bed in HDU after undergoing surgeries or intensive treatments from ICU or surgical theaters. Such patients may not be fully capable of handling things themselves like a general ward patient but may be in better health than ICU patients. HDU provides non-invasive ventilation to the required patients.
What Are the Features of a High-Dependency Unit?
High-dependency units are also called step-down units, intermediate or progressive care units. The following points explain some features of HDU:
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Patients requiring constant observation, nursing care, and treatment will be shifted to the high-dependency unit.
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The care provided in an HDU will be less intense than in an ICU and more than in the general ward.
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The number of staff in a high-dependency unit may be less than in an intensive care unit.
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A high-dependency unit contains fewer specialized devices or equipment compared to an ICU.
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In some hospitals, ICU and HDU may be separated. In other instances, both may be combined by allotting some ICU beds for HDU-related purposes.
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Depending on the illness and its severity, the time the patient spends in the HDU varies.
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Patients may get admitted to the HDU before or after surgeries or other treatments based on the patient’s health condition.
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Critically ill patients may get stabilized in the HDU before shifting them to the intensive care unit.
The following types of patients will be admitted or shifted to a high-dependency unit:
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Patients who recovered from a critical illness or injury after receiving emergency treatments from the intensive care unit.
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Patients who do not require invasive hemodynamic monitoring.
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Patients whose severity of sickness or injury is less.
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Patients who do not require invasive mechanical ventilation.
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Patients who need close monitoring or observation.
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Patients who are not in shock but require close observation.
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Patients without multiple organ failures need constant monitoring.
Will the Patient Get Shifted From HDU to ICU?
Patients may get shifted from high-dependency units to intensive care units due to the following reasons:
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When the patient's health condition starts getting worse, the requirement for invasive ventilation gets inevitable.
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If the patient develops multiple organ failure syndrome or multiple organ dysfunction syndrome or MODS (it is a critical complication due to the damage caused to two or more organs in the body).
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During the requirement of vasopressor (increases blood pressure and lets the organs get more blood supply) or inotropic support due to hemodynamic instability of the patient.
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When the patient requires intensive and continuous monitoring.
When Does the Patient Get Shifted From an ICU to an HDU?
After their severity subsides, the critically ill or injured patients may be subjected to further observation for stability. If they stay stable for about twelve to twenty-four hours, they may be qualified to get shifted to the HDU. Since the signs and symptoms may worsen in the future, close observation and prompt decision-making are necessary regarding the step-down shifting of the patient. Even in the high-dependency unit, the patients should be closely watched initially to confirm that they are stable and recovering. If the patient's condition worsens, they should be immediately shifted to the intensive care unit, and required assistance should be provided on an emergency basis. In the HDU, if the patient gets cured and is more stable, they can be shifted to the ward.
Who All Provides Treatment in a High-Dependency Unit?
A high-dependency unit may contain a team of professionals doing the following jobs:
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Medical Officer: A medical officer is trained to do basic tests and procedures for the patient. They can also assess the patient's qualification for admission to the HDU or ICU. In addition, they handle the equipment and interpret the diagnostic tests to be carried out and the test results.
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Intensivist: Intensivists are trained to manage critically injured or sick patients.
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Specialists: HDU may contain doctors specialized under different streams to treat the patients based on their injury or illness. They may also include specialists trained to provide adequate medications or anesthesia. They may assess the patient and plan for future treatments.
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Nurses: Nurses are trained to provide medicines at required intervals, assist the doctors while doing procedures or diagnoses, performing basic steps like nebulization, airway suction, etc. They are responsible for closely observing the patient and noting down the changes. The details will be stored as records under each patient's name, and the nurse will be responsible for keeping the details. They are trained to administer medicines through all the routes to the patient.
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Dietician: The dietician assesses the patient’s condition and prepares diet charts suitable for the patient. A dietician should be able to understand the basic diagnostic reports and prepare a diet chart that suits the patient's medical status. Consumption of food not suitable for the person can lead to severe effects.
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Physiotherapist: No critical cases will be admitted to the HDU. They help the patients manage pain, functioning, mobility, and balance. They will also advise patients about the importance of stretching and teach them basic self-doable physiotherapy steps.
In addition to the team mentioned above of healthcare professionals, an HDU may also contain a technician (one who helps operate equipment or devices for diagnosis and treatment purposes), a bio-medical engineer (helps maintain the condition and functioning of the equipment), etc.
Conclusion
High-dependency unit plays a vital role in critical care. It acts as a transition phase between the intensive care unit and the general ward. HDU contains staff who closely observe the patients and provide required medicines and treatment. The patients may get shifted to the ward or ICU, depending on the severity and stability of their condition.
