Close Observation Units

A close observation unit (COU) provides an intermediate level of care between a general ward and an intensive care unit. 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

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

Establishment, governance and operation of a close observation unit: key principles

Organisational models

The scope of care provided by a COU will depend on whether there is an ICU 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.

Close observation unit (COU) organisational models

Implementation tools