Clinical decision units: A new development for emergency medicine in the United Kingdom

Emergency medicine in the United Kingdom is in the midst of significant change and increasing demand. Admissions to the in-hospital bed base cause significant pressure on emergency departments (ED) which face increasing congestion. In Leeds, a city with a population of approximately 800 000, there has been a 15.9% increase in medical admissions over the past 10 years. This is in keeping with other developed countries whose emergency care systems are also being stretched to the limit.1,2 Recently, Government attention in the UK has been focused particularly on this increasing volume of unscheduled care. ‘The National Health Service (NHS) Plan’ and ‘Reforming Emergency Care’ both set standards for processes of care in ED. They suggest potential solutions to encourage the development of new schemes to try to control the increasing numbers of medical admissions.3,4 The problems are best seen as a failure in the overall system with inadequacies in the bed base (bed occupancy levels are frequently in excess of 95%), inefficiencies in the way patients are managed within the ED and difficulty in accessing safe discharge, contributing to the systems failure.5 Until now there have been few clearly defined strategies from within the ED to provide a system solution to help in some way in solving these problems.