Ambulatory Diagnostic and Treatment Unit

ADTU Clinic Model Summary – Taubman Health Center

ADTU Summary and Purpose: The clinic is established to diagnose and treat acute conditions oracute exacerbations of chronic conditions that may require extended time for appropriate diagnosis and treatment. To be referred to the ADTU, a patient must have an established relationship with a Taubman provider(must have been previously seen at Taubman Health center by provider referring patient to the ADTU) and a defined problem that is able to be diagnosed and treated in the ADTU in a period of 2 to 6 hours. The ADTU helps to ensure there is a coordinated plan for clinical and diagnostics services (including priority Lab tests and Radiology exams) to enhance patient access and convenience for a variety of complex patient conditions requiring care that extends beyond that provided in a typical clinic visit.

Patient Referral and Hours of Operation: Patients must be referred to the ADTU clinic by their provider based on established protocols and patient conditions acceptable for testing/treatment in the ADTU. (See inclusion and exclusion criteria below) The ADTU will operate from 8:00am to 6:00pm Monday – Friday.

Patient Discharged from the ADTU: Following discharge from the ADTU a summary of the patient’s visit will be directed to the referring provider. Care of the patient will then be resumed by the referring service. (The discharge summary will be completed at the end of the APP’s shift.)

Planned Scope of Services:

  • Stat Lab (CBCPD, basic panel) and Radiology (General Radiology, ultrasound, DVU as needed)
  • Hydration and medications including infusion therapy (no blood transfusions)
  • EKG, breathing treatments including oxygen
  • Urinary catherization

ADTU: Inclusion criteria for Patient Conditions

  • GI/GU: Nausea, vomiting, diarrhea, constipation, abdominal pain, urinary retention, dysuria, flank pain
  • Urology: hematuria; catheter obstruction – flushing; kidney stone
  • Cardio/Pulmonary: increased shortness of breath, CHF , COPD/- or asthma flare, mild fluid retention, cough
  • Musculoskeletal: Joint pain and/or swelling, rheumatologic disease flare
  • Pain: known condition for migraine
  • General conditions: fever, cellulitis, newly diagnosed or symptoms of DVT, dehydration, elevated blood sugar (without ketosis) community acquired pneumonia (non-immuno-compromised)
  • Uncontrolled hypertension (notes- if chest pain or TIA- send to ED)
  • Hyperkalemia w/o associated worsening kidney function (* EKG treatment)

ADTU: Exclusion criteria for Patient Conditions

  • Controlled substances dependence/addiction
  • Respiratory isolation required: known or suspected TB, pertussis, disseminated shingles, measles, mumps, rubella
  • Unstable airway/ Unstable hemodynamics
  • Chronic dialysis
  • Acute neurological deficits/status
  • Suspected cardiac event, tachyarrhythmia
  • CF patients w/ new respiratory symptoms/ Home ventilator
  • Congestive Heart Failure/Chest pain
  • Pain: Pain control, e.g. acute flare (for conditions other than those listed in the inclusion criteria)
  • Ketosis

Proposed Protocols for Patient Treatment

Service Developing Protocol / Protocols for Patient Treatment
Pulmonary / Asthma, COPD Exacerbations. Pneumonia, Persistent cough/Bronchospasms
Urology/Renal / Hematuria, UTI, catheter irrigation, surgical wound evaluation,
Abdominal Pain - suspected renal colic
GI / GI bleed (w/ stable hemoglobin), Diverticulitis, Nausea, Vomiting, Diarrhea, constipation
General Medicine or other Taubman Specialties / Hyperglycemia,
Hypertensive Urgency, Volume under-load/overload
Cellulitis
Dehydration, Incision & Drainage, (Gen Med/Infectious Disease)
Dysuria, Rule-out UTI
Deep Vein Thrombosis
Transplant
Pre-transplant patients / Neutropenic Fever ( w/ other symptoms/indicators)
Surgery/ Orthopaedics/ Otolaryngology/ Urology/Ostomy / G-Tube, Trach change, Wound debridement, Superficial Incision & Abscess Drainage
Neurology / Headache without focal CNS changes, Sciatica, seizure med loading
Nephrology / Hyperkalemia
Rheumatology / Gastroenteritis
Lupus flare
Rheumatoid Arthritis flare
Septic Joint

Updated: December 10, 2015