What Is A High-Dependency Unit? (HDUs Explained)

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

I canโ€™t say I really understood what a high-dependency unit (HDU) was until I started referring and receiving patients from one as a junior doctor.

A high-dependency unit (HDU) is a specialised area within a hospital that offers a higher level of care than a standard ward. Often situated close to the intensive care unit (ICU), it caters to patients who need extra attention, monitoring and treatment, but not to the extent of requiring intensive care.

This type of care is specifically suitable for patients who have undergone major surgery, those with single-organ failure or other complex conditions that warrant closer supervision.

As the name implies, patients admitted to an HDU have a higher dependency on nursing staff and medical attention compared to those in regular wards.

In this article, Iโ€™m going to further delve into why HDUs can be so valuable to hospitals as well as looking at some of the potential challenges they face.

Understanding High-Dependency Units

HDUs are usually located close to the ICU (Intensive Care Unit) for easy accessibility and often share staff members with the ICU to ensure seamless care provision.

In some hospitals, HDUs are also known as step-down units, progressive care units, or intermediate care units, reflecting their intermediary position between general ward care and intensive care.

Patients who may be treated in an HDU often include those who have undergone major surgery or those with single organ failure.

The level of care provided in an HDU is more intensive than that of a general ward, offering patients additional support like non-invasive breathing assistance, feeding support, or specialist treatment.

In some instances, an HDU may cater to specific patient groups, such as premature infants in a neonatal high-dependency unit.

A respiratory high-dependency unit specifically cares for patients with severe respiratory issues.

These patients might be too unwell for a general ward but not critically ill enough to warrant admission into the ICU.

The high-dependency unit has specially trained staff and is equipped with advanced medical technology to handle the unique needs of its patients.

A consultant ward round takes place at least once daily, ensuring continuous monitoring and management of patients’ conditions.

Purpose Of A High-Dependency Unit

Acting as that intermediary between ICU and the general wards, a high-dependency unit fulfils some important functions within a hospital.

Immediate Postoperative Care

One of the primary purposes of an HDU is to provide immediate postoperative care for patients who have undergone major surgery.

These patients often require close monitoring and specialised care during the initial recovery phase.

This may include pain management, monitoring of vital signs, and early mobilisation to aid in recovery.

Monitoring Of Complex Conditions

Patients with complex medical conditions may require more extensive monitoring and treatment than can be provided on a general ward.

The HDU serves as a specialised environment for managing conditions such as single-organ failure and ensuring that patients receive the necessary support and care.

This often includes close monitoring of vital signs, administering medications or intravenous fluids, and providing a higher level of nursing care.

Transition Between Intensive Care And A General Ward

As mentioned, another important purpose of an HDU is to provide a step-down level of care for patients transitioning from the ICU to a general ward.

This transitional period helps ensure a smooth recovery process and reduces the risk of complications.

The HDU can also serve as a step-up unit for patients who need to be transferred from a general ward to a more specialised care setting.

Staff And Equipment In A High-Dependency Unit

HDUs are equipped with specialist equipment and staff able to deal with the sicker-than-average patients who get admitted.

Nursing Staff

In a High-Dependency Unit (HDU), nursing staff play a crucial role in providing care for patients who require close monitoring and attention.

The nurses in this unit are highly skilled and experienced in managing patients at an intermediate level between intensive care and general ward care.

They work closely with doctors and other healthcare professionals to ensure the best possible care for patients.

Medical Equipment

A High-Dependency Unit is well-equipped with essential medical equipment to provide appropriate care for patients.

Some common types of medical equipment in an HDU may include:

  • Vital signs monitors: These devices monitor a patient’s heart rate, blood pressure, and respiratory rate, amongst other parameters.
  • Infusion pumps: Used for administering medications, fluids, and nutrition to patients.
  • Oxygen delivery systems: Provide necessary oxygen to patients who might be experiencing respiratory issues.
  • Cardiac defibrillators: Used to treat life-threatening heart conditions such as cardiac arrhythmias, or in cases of cardiac arrest.

Specialist Equipment

In addition to standard medical equipment, High-Dependency Units may provide access to specialist equipment for specific patient care requirements. For example:

  • Non-invasive ventilation systems: These systems assist patients with breathing difficulties without the need for intubation.
  • Telemetry systems: These systems enable continuous remote monitoring of patients’ vital signs and medical data, allowing healthcare professionals to respond quickly to any changes in a patient’s condition.

Patient Admission Criteria

Each hospital will have its own admission criteria for their High Dependency Unit.

The policies are defined based on the hospital’s resources, staff capabilities, and the specific needs of their patient population.

While the admission criteria may vary between institutions, they generally follow established guidelines to ensure that patients who need the higher level of care available in the HDU receive it promptly.

Severity Of Illness

A patientโ€™s severity of illness is a key factor in determining admission to the HDU.

Patients with potential or established organ failure, requiring frequent monitoring or support for vital functions, are often candidates for admission to the HDU.

These are the sort of care needs that often wouldnโ€™t be able to be met on a general ward.

Type Of Surgery

Certain types of surgery, especially major surgeries, may often necessitate a stay in the HDU.

Post-operative patients who need closer monitoring are admitted to the HDU as a precautionary measure.

Planned admissions to HDU are coordinated with the surgery schedule to ensure appropriate care is available when needed.

Difference Between HDU And ICU

While High Dependency Units (HDUs) and Intensive Care Units (ICUs) are both specialist wards designed to provide care for critically ill patients, there are a few key differences between the two.

One of the main differences is the nurse-to-patient ratio.

In ICUs, patients generally receive one-to-one nursing care, meaning that each patient has a dedicated nurse attending to their needs.

On the other hand, in HDUs, one nurse typically cares for two or more patients, providing a slightly lower level of care compared to an ICU.

Another distinction is the level of organ support required by patients in each unit.

Patients in ICUs often need support for multiple organs and may require mechanical ventilation.

In terms of staffing, ICUs usually have a doctor present 24 hours a day to provide continuous supervision and treatment, whereas HDUs may not always have a doctor on the ward around the clock.

Benefits Of High Dependency Units

HDUs offer improved patient outcomes by providing a tailored environment for patients who need more attention than a general ward.

This individualised care increases their chances of recovery and reduces mortality rates.

Another benefit of HDUs is their efficient use of resources.

By allocating patients to HDUs, hospitals can ensure that their intensive care units are reserved for those with the most critical needs, thus optimising the use of equipment, staff, and other resources.

An additional advantage of an HDU is the flexibility in treatment options.

HDUs can cater to a versatile range of needs, such as non-invasive breathing assistance, feeding support, or post-operative care.

This means patients receive the most suitable care for their specific conditions.

Potential Challenges In A High-Dependency Unit

While HDUs broadly run smoothly, there are several potential challenges that healthcare providers and patients may face.

Increased risk of infection: Since HDU patients often suffer from serious underlying diseases and undergo numerous invasive interventions, they are at a higher risk of infection.

Staffing and resource allocation: HDUs demand more intensive observation, treatment, and nursing care than general wards. Striking the right balance between providing sufficient staff/resources to the HDU and allocating them efficiently throughout the rest of a hospital can be challenging.

Communication and coordination: Serving as a ‘step-up’ or ‘step-down’ unit between general wards and paediatric or adult ICUs, effective communication between the various wards and healthcare providers is crucial to ensure seamless patient care and coordination.

Final Thoughts

In summary, high-dependency units play a crucial role in healthcare facilities, offering an intermediary level of care for patients with more extensive needs than a general ward can provide but not requiring the full intensity of an ICU.

These units ensure proper care and monitoring, helping patients transition from one level of care to another safely and effectively.

While High-Dependency Units donโ€™t come without their challenges, they do broadly provide a higher quality of care to patients in an efficient and streamlined manner.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.