Provision of medical Same Day Emergency Care services within the UK: analysis from the Society for Acute Medicine Benchmarking Audit
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Aim
To evaluate current provision of medical Same Day Emergency Care (SDEC) services within the UK, and current utilisation of these pathways in the assessment of unplanned medical attendances.
Design
Survey data was used from the Society for Acute Medicine Benchmarking Audit (SAMBA), including anonymised patient-level data collected annually using a day of care survey
Setting
Hospitals accepting unplanned medical attendances within the UK, 2019-2023. Participants: 34,948 unplanned and 4,342 planned attendances, across 188 hospital sites
Results
29.8% of unplanned medical attendances received their initial medical assessment within SDEC services, with the proportion increasing over time. 82.4% of patients assessed in SDEC services were discharged without overnight admission. Assessment in SDEC services was less likely in male patients, patients with frailty, and older adults (all p<0.005).
Selected operational standards for SDEC delivery were met in 64-91% of hospitals. Most hospitals (82%) accepted referrals from emergency department triage and 63% accepted referral directly from the paramedic team. 38% of hospitals did not use a recognised selection criteria to identify suitable patients for SDEC and only 8% used a criteria designed to identify patients suitable for discharge. Overall, 34.7% of medical attendances discharged without overnight admission received their medical assessment in locations other than SDEC.
Conclusions
Medical SDEC provides assessment for one third of patients seen through acute medicine services. Although the proportion of patients assessed within SDEC is increasing, further innovation and improvements are needed to ensure appropriate patients access this service.
Strengths and limitations of this study
-Medical same day emergency care (SDEC) has been widely adopted in the UK to deliver care to patients without overnight hospital admission, however there is limited evidence guiding development of this service.
-This study compares hospital-level data describing SDEC service structure and processes, and patient level data for over 35,000 patient attendances at 188 hospitals in the UK.
-This is the largest evaluation of medical SDEC to date and demonstrates an increase in the use of SDEC for medical patients nationally.
-The participation rate was higher amongst hospitals in England compared to the other three UK nations, which may limit generalisability.
