The Children’s High Dependency Unit (CHDU) Information for families/carers

The Children’s High Dependency Unit (CHDU) is a self-contained area with four cubicles, of single and double rooms, with an open plan nursing area. It is mainly for children and young people under 18yrs of age, who have had spinal or orthopaedic surgery but we also care for adult patients who may need may respiratory care.

The aim of the CHDU is to offer closer monitoring and nursing to children who have had complex or major surgery. It acts as an intermediate or “step down” between Theatres and the children’s and adolescent unit (Coxen Ward).

For security reasons, the doors to the unit are kept locked. Please buzz for assistance. There may be a delay with someone responding as they may be doing personal care with a patient. Please be patient with us.

There are many reasons why your child might need a stay in CHDU:

• Your child may have had a complex or major surgical procedure which may mean they need closer monitoring for a while after their operation

• Sometimes, before a complex or major operation, your child may have a short stay on CHDU for optimisation before surgery, especially if they have particular health issues or risk factors.

• Children and young people who have an artificial airway, such as a tracheostomy, or are using breathing support such as at home NIV, may need closer monitoring after their anaesthetic.

• If your child becomes unwell on their host ward, then they may need to be transferred over to CHDU for closer monitoring.

We will explain the particular reasons why we think your child will benefit from a stay on CHDU.

The aim of the CHDU is to be a “stepping stone” back to their host ward to finish their recovery before being discharged. In some cases, only one night in CHDU is needed after an operation, but in others, particularly after major surgery, or those with complex needs, children may need to stay a number of nights in CHDU.

Each day, the unit team will assess your child in CHDU to review whether they still require closer monitoring or whether they can be transferred back to their host ward.

The nursing team includes a Lead Nurse, Clinical Nurse Managers, sisters & charge nurses, staff nurses and students at various point in their training.

There is a team of paediatric doctors, who you may recognise from the ward, and will also come daily and review all the children on CHDU.

The multidisciplinary team who are also involved in your child’s care include physiotherapists, occupational therapists, a pharmacist, dietician and support workers. We can also access the play specialist, hospital chaplain and hospital school, if required.

The nursing staff have specialist experience in high dependency care and the majority have had training in intensive care. Your child will remain under the same surgical team throughout their stay at the RNOH.

Children on the unit will be nursed by qualified nurses on a one-to-one basis. You will see a number of newly qualified nurses and students who will always be supervised by a qualified nurse.

We encourage you to take part in your child’s care as much as you feel able. Talk to your child’s nurse about what you would like to do, such as washing and feeding. As long as it is safe to do so, you should be able to help the nurses look after your child.

Parents/carers can visit at any time but visiting times for other relatives and friends are between 2pm and 7pm. This can be more flexible under the discretion of the nurse in charge. As space is limited and the nurses need to be able to access your child, we ask that a total of only two visitors are at the bedside at any time. You are welcome to bring siblings to visit up to 7pm but they should always be supervised by a responsible adult. One Parent/carer should be the only visitor after 7pm. You are welcome to telephone at any time.

We are working hard to reduce the risk of infection so we ask that you and your visitors take off your coats and use the sink to wash your hands and use the alcohol gel before you see your child and afterwards as well.

If you or any visitor has been in contact with coughs, colds, tummy bugs, chicken pox or measles, we respectfully request that you wait until you are better before visiting. If in doubt, please speak to the nurse in charge.

We recognise that having a child in HDU can be stressful and you want to be near them at all times. We can offer overnight accommodation at the bedside for one parent/carer. Each bedspace has a fold-out bed allowing you to rest by your child’s bedside. Basic linen can be provided, i.e. sheet & blanket, but you will need your own pillow, toiletries and other supplies.

Facilities for patients/carers Meals are not provided for parents/carers, but food and drink can be bought from various catering facilities within the hospital.

Food and drink MUST NOT be brought into your child’s cubicle.

There is a seating area in the foyer just outside the unit, where relatives & friends are welcome to use.

Facilities for the child/young person We can arrange for the play therapist to provide age-appropriate play/distraction opportunities. The play specialist will also help to make sure that siblings’ needs are met and can provide games, puzzles, books etc.

You are welcome to bring in a favourite toy or game for your child as long as it does not take up a lot of space nor stop the nurses caring for your child. A tablet with access to games or YouTube may suffice. Everything you bring in should be washable /wipeable to reduce the risk of infection. You can also bring in a recent photograph of your child and their family to be put by his/her bed. Please note that the RNOH cannot accept liability for damage to or loss of any personal property.

You can use your mobile phone within the grounds of the hospital but remember it can be disruptive to other families and to the staff caring for your child. If friends or relatives call, we will take a message but please ask them to make contact with the parent/carer (i.e. their Next of Kin).

Nurses cannot give information about a patient to anyone except his or her parents/ carers.

Please limit the amount of clothes, toiletries and personal belongings you bring to the unit as space is limited. If your child uses equipment such as a CPAP or BiPAP machine or a feeding pump at home, please bring them with you. If you have additional equipment at home, please discuss this with us before you bring it to the unit.

The following are NOT allowed on the unit:

• Flowers – water in the vase can develop a bacterium that can cause infection

• Latex balloons – due to potential allergy

• Hot food or drinks of any kind

• Photography and videography is NOT permitted on the ward, without the consent of the child/patient.

We will let you know once the team has decided that your child is ready to be transferred back to their host ward. The nurse allocated to your child on CHDU will be the same nurse handing over to the nurses on the host ward. There will be fewer nurses looking after your child, but they will, of course, continue to monitor your child’s recovery along with other children and young people on the unit. Children who have been an inpatient on CHDU for over 48 hours may be followed up on their host ward by a member of the Acute Intervention Team, until they are discharged from their care.

Please remember … Everybody on the unit is here to help you and your child. You should feel free to ask any questions or query anything you don’t understand or you are uncomfortable with.

Phone Switchboard: 0208 954 2300

Phone Direct Dial: 020 8385 3303 / 3304

24-21 © RNOH

Publication date: April 2024

Date of next review: April 2026

Caterina Ferrara - Critical Care Sister