A high dependency unit (HDU), also known as a step-down unit or level 2 care area, is a hospital ward that provides intensive monitoring and specialist nursing care for patients who are more seriously ill than can be managed on a general ward, but who do not require the full level of organ support of an intensive care unit (ICU). The nurse-to-patient ratio in an HDU is typically 1:2 to 1:3, intermediate between a general ward and an ICU.
HDU care is appropriate for patients requiring one organ system to be closely supported or monitored, such as those receiving vasopressor infusions for blood pressure support, non-invasive ventilation (CPAP or BiPAP) for respiratory failure, continuous cardiac monitoring for arrhythmias or post-procedure recovery, or invasive arterial blood pressure monitoring. Patients stepped down from ICU after cardiac arrest recovery often pass through the HDU before returning to a general ward.
In the cardiac arrest care pathway, HDU is frequently the intermediate destination as a patient progresses through recovery. Once weaned from mechanical ventilation and vasopressors in the ICU, but still requiring continuous monitoring and close clinical assessment, a patient will typically be stepped down to HDU. This step-down is a positive sign of clinical improvement and reduced dependence on organ support.
Families should be aware that HDU step-down does not mean their loved one is ‘nearly better’; it means the most intensive level of support is no longer required. Monitoring, nursing assessment, and medical review continue in the HDU, and the patient may be stepped back up to ICU if there is any deterioration.
« Back to Glossary Index