A close observation unit (COU) provides an intermediate level of care between a general ward and an intensive care unit.
The resources on this is page describe the principles, organisational models and tools to deliver safe, effective and timely care in a COU in NSW.
A COU may be established in a hospital with no intensive care service (i.e. a level 3 COU) or in a hospital with a level 4, 5 or 6 intensive care service (i.e. a level 4 COU). These units may have historically been referred to as high dependency units or coronary care units, depending on the scope of services delivered.
Key principles
Published: May 2018. Next review: 2024.
To deliver safe, effective and timely care in a COU, it is recommended that local health districts and specialty health networks adopt the following key principles:
- Clarity of leadership and governance arrangements
- Definition of care delivery and coordination mechanisms
- Documentation of protocols, procedures and treatments
- Proactive continuous quality improvement practices
- Structured education and training programs
- Appropriate workforce and support staff resourcing
- Availability of necessary equipment to deliver care within the defined scope of the COU
Organisational models
Published: April 2022. Next review: 2027.
The scope of care provided by a COU will depend on whether there is an intensive care unit on the same hospital site.
This document outlines the options and clinical requirements for the delivery of care within a COU at a local hospital.
Download the Close observation unit (COU) organisational models (PDF 244.9 KB)
Implementation tools
- COU self-assessment tool (XLS 690.0 KB)
Assess your current unit practices against recommended COU principles. Identify areas that require further development.
Published: 2018. Next review: 2024. - ACI implementation Guide: Putting a model into practice (PDF 1.2 MB)
Use this guide to plan, assess and operationalise changes to your COU.
Published: 2018. Next review: 2024. - COU medical record audit tool (XLS 495.7 KB)
Review patient medical records and assess alignment of current clinical practices with recommended COU principles.
Published: 2018. Next review: 2024. - COU risk and issues log template (XLS 189.0 KB)
Identify risks and issues associated with change processes, classify the likelihood and impact of these and track progress of mitigations strategies in your COU.
Published: 2018. Next review: 2024.