What is a Definitive Observation Unit?

Mary McMahon

A Definitive Observation Unit (DOU) is a unit in a hospital that provides the second-highest level of care. Patients may be booked directly into the DOU when they arrive at the hospital, or they may be transferred into the unit from the Intensive Care Unit (ICU) once they have been stabilized. A wide variety of patients may spend time in one, receiving attentive care from specially trained nurses and medical teams.

Definitive observation units are units in which patients receive a level of attention second only to those in intensive care.
Definitive observation units are units in which patients receive a level of attention second only to those in intensive care.

The highest level of care in a hospital is an ICU. ICUs are designed for extremely sick patients who require constant monitoring. Often, the nurse to patient ratio is 1:1 or sometimes even 2:1 to ensure that patients have around-the-clock care from attentive personnel. Patients who are in the ICU are often unstable, which means that they may require medical interventions to stay alive.

Patients may be moved to a definitive observation unit after they have been stabilized through surgery.
Patients may be moved to a definitive observation unit after they have been stabilized through surgery.

In a Definitive Observation Unit, patients still require a lot of attention, but their conditions are not as critical as those of ICU patients. Nurses still check on patients at least once every four hours, and they use telemetry to monitor patients. Telemetry systems take measurements at the patient's bedside and report them to a nursing station or monitoring room, allowing staff to see when a patient is in distress.

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Telemetry plays an important role in monitoring patients in a definitive observation unit.
Telemetry plays an important role in monitoring patients in a definitive observation unit.

Some people may hear a DOU referred to as a Direct Observation or Telemetry Unit. Some hospitals call such units “step down units,” referencing the idea that it is a step down in care from the ICU. Being moved to a step down unit from the ICU is a cause for celebration, as it indicates that the patient's prognosis is improving.

The DOU is typically used for patients who need a high level of care, but are medically stable.
The DOU is typically used for patients who need a high level of care, but are medically stable.

Usually, the unit has restricted visiting hours, because patients are often tired and still working hard to recover. Patients work with a team of doctors to address their conditions, and they may also have access to physical therapy, psychological counseling, and other treatments that are designed to reduce the trauma and long-term effects of their stay. Typically, the diet of patients in the DOU is also restricted, with a nutritionist determining what the patient should eat and when to hasten recovery.

If a friend or family member is in a Definitive Observation Unit, visitors should check with hospital staff about who is allowed to see the patient and when. Visitors should be prepared to see the patient connected to medical equipment, and if the patient appears strained or stressed, they will be asked to leave. Patients are usually very happy to have visitors while in the hospital, however, especially if the visitors come bearing gifts, so the effort of making a DOU visit is usually worth it.

Patients in the DOU often still require care from a team of medical professionals, although they are typically not as sick as those in intensive care.
Patients in the DOU often still require care from a team of medical professionals, although they are typically not as sick as those in intensive care.

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