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Labs or history consistent with clinically significant APAP Ingestion, OR supratherapeutic APAP concentration (>20mcg/mL), OR unexplained LFT elevation with suspicion of APAP use at unknown time In • Unexplained LFT elevation with detectable APAP concentration

Patient with alcohol intoxication or clinical concern for alcohol intoxication who requires continued ED observation. 

Patient in alcohol withdrawal who needs continued SEWS evaluation and treatment.

Patient with CT confirmed appendicitis and meets criteria for non-operative management per EGS team.

Patient with history of asthma who requires more than 2 hours of ED care to improve their symptoms (wheezing, respiratory rate, oxygen level). 

Patient with back pain with persistent significant pain/unable to ambulate after adequate pain control attempt in the emergency department with or without MRI ordered OR back pain with deficit or concerning history requiring MRI.

Post bariatric surgery patient presenting to the ED with nausea, vomiting, abdominal pain, poor po intake, or bleeding. 

Patient with signs and symptoms consistent with cellulitis and/or with associated drained abscess and no clinical concern for deep space infection.

Patient with a HEART score of 6 or less with resolved chest pain, completed NORMAL HsTrop Algorithm, and need for a stress test for further evaluation of chest pain if concern for cardiac cause.

Stress Test Options and Decision Algorithm

Patient with a HEART score of 6 or less with resolved chest pain, completed NORMAL HsTrop Algorithm and needs anatomic testing to evaluate cardiac disease (determined by Cardiac Imaging Team while in CDU)

Patient with history of CHF (by prior documented echo) AND likely to be discharged within 24 hours.

Patient with history of COPD who requires more than 2 hours of ED care to improve their symptoms (wheezing, respiratory rate, oxygen level).

Patient who needs further observation in the emergency department based on vital signs or provider request to determine if they are safe for discharge home or admission to the hospital

Patient with CT or US confirmed Appy or Chole AND discharge plan (ride and caregiver arranged for dc from PACU)

Patient with dehydration secondary to poor oral intake, vomiting, and or diarrhea.

Patient with suspected need for cholecystectomy based on ED POCUS and ED Attending review

Patient with signs and symptoms consistent with acute foot cellulitis and/or with associated drained abscess in whom concern for ischemic pathology has been ruled out.

Patient with presumed upper GI bleed (BRB or coffee-ground emesis, melena, maroon/red stools).

Patient with esophageal or gastric foreign body amenable to endoscopic removal.

Patient on therapeutic anticoagulation who sustained a closed head injury (not due to syncopal injury) with initial CTH imaging completed, GCS 15, and no focal neurologic deficits who requires further 12 hour observation and/or repeat CTH.

Patient with history of ESRD requiring 1 run (determined by Renal Service) of hemodialysis due to electrolyte abnormalities, acidosis, uremia, or fluid overload

Patient with a blood glucose of 300-600 mg/dL with a treatable, reversible cause. 

Patient with CTH findings of punctate hyperdensity, small subarachnoid hemorrhage or subdural hemorrhage without mass effect/shift who need serial neurologic exams or repeat CTH. 

Patient with history of opioid use disorder current IN withdraw or at risk.

Patieht with moderate to severe alcohol use disorder interested in medication to help with cravings to help reduce or elimnate use.

Patient with short acting (fentanyl, heroin) opioid overdose who received Naloxone in the emergency department or prior to arrival with EMS or bystander.

Patient with occult PTX seen only on CT but NOT on initial CXR with no hemodynamic instability, other injury necessitating admission, or hypoxia. 

Patient with upper abdominal pain, elevated lipase, imaging concerning for acute pancreatitis, or clinical concern for pancreatitis requiring further emergency department observation and treatment. 

Patient who requires assessment by physical therapy and pain management for disposition planning or for additional assistive devices with an anticipated LOS less than 18 hours.

Patient with findings consistent with community acquired pneumonia with or without hypoxia (3L max)

Patients with diagnosed PE and identified as low risk as determined by the Denver Health Algorithm who need short stay management, observation, and DOAC initiation.

Patient with lab, physical, and history evidence of pyelonephritis requiring extended observation due to concerning vital signs or inability to tolerate oral antibiotics

Patient requiring a SANE evaluation who has been medically cleared or does not need medical clearance.

Patient with transient loss of consciousness and postural tone with spontaneous complete recovery.  

Patient with concern for a TIA or minor stroke who has a completed CT evaluation who does not require TPA and who has a neurology consult started. 

Patient involved in a trauma who is intoxicated and requires more than 4 hours of observation.

Patient with lab confirmed viral pna requiring hospitalization due to need for oxygen therapy (less than 4L) OR other clinical concern. 

Clinical Decision Unit Application - DISCLAIMER – July 27, 2023

This Clinical Decision Unit Application ("Application") has been created for the Denver Health and Hospital Authority ("Denver Health") and is intended for informational purposes only. Although Denver Health attempts to keep this information as accurate as possible, Denver Health makes no guarantees or warranties of any kind, express or implied, with respect to the use of this Application.

This Application is not intended to be, nor should it be used as a substitute for, the professional medical advice or analysis required when evaluating and caring for a Denver Health patient or any patient outside of Denver Health. Use of this Application is not intended to, nor does it create, a physician-patient or healthcare provider-patient relationship between Denver Health and the user or the user's patient. Application users assume full responsibility for any actions taken on the basis of the information obtained from use of the Application and agree that Denver Health bears no responsibility for any claim, loss or damage caused by or related to its use.

Since Denver Health has no legal obligation to update the information provided on this Application, Denver Health cannot ensure that all information reflects the most up-to-date information regarding Observation Medicine and Emergency Medicine. Denver Health may make changes or improvements to this Application at any time without notice or announcement. Application users outside of Denver Health should consult their local facility policies and procedures regarding Surgical and Trauma guidelines for their institutions and practice sites.

If you have any questions about this disclaimer or any other information contained in this Application, you can contact the Clinical Decision Unit Leadership team.

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