Publish date: 20 May 2021

UCLH has for some time had an acute medicine ambulatory pathway co-located with an emergency assessment area. Activity in this area has tripled in the past three years and continues to be busy in providing care during COVID-19. We want to build on this work and have been collaborating with other specialty teams to develop similar services for non-acute medical emergency patients.

Development of same day emergency care (SDEC) is part of the NHS long term plan and is also a key component of post-COVID-19 emergency care strategies locally, regionally and nationally to reduce crowding in EDs and to streamline care, improving patient experience.

What is SDEC?

SDEC was previously known as emergency ambulatory care. The aim is to deliver care that should not be realistically delivered under the four-hour standard but in a format whereby unnecessary admission for tests and treatment is avoided. As such it can be considered ‘emergency day care’. It is distinct from elective or planned medical or surgical daycare.

Where is SDEC?

SDEC comprises of 36 clinical spaces located across the old UTC area (currently Specialty Assessment Area), EAU and Ambulatory Care areas. There is also a treatment room, plaster room and ophthalmology room.

What is the pathway within SDEC?

All (ambulant and non-ambulant) patients that are referred to specialties as an emergency and are not requiring resuscitation-level care will be transferred to the SDEC area. Nursing assessment will be done, diagnostics requested and specialty teams will review patients, making an early decision on (a) definite admission, in which case a bed will be requested and transfer undertaken or (b) ongoing care in SDEC aiming for a same day discharge (within 6 hours of arrival). Patients will be able to access point of care diagnostics and imaging as per all emergency floor patients. Expected patients will route to the area directly following assessment at navigation. Finally we will be able to accommodate some next day return for morning review. The area will be open 24/7 for urgent, same day reviews.

How is the area run and overseen?

Our emergency services nurses (AMU and ED) will deliver nursing care and our operations team (including floor managers and flow coordinators) will oversee the area, working with specialty clinical leads and divisional teams. We will oversee clinical governance through our weekly governance meeting. There will be some supporting junior doctor support to the area for surgical patients alongside an emergency medical response team provided by acute medicine. We are working closely with the coordination centre on this project and one of this team will be based in the area to oversee flow from SDEC to beds.

It will be expected that specialty teams review SDEC patients within 30 minutes unless otherwise detained, and there will be regular reviews of those not for immediate admission to determine whether discharge at 6 hours is still possible.

Is this a hot clinic?

In general no. We have defined, within NCL a hot clinic as an urgent outpatient encounter delivered within 2-5 days of referral whereby care can be delivered in an outpatient context (clinical review, phlebotomy) and emergency care does not require extended stay, procedures, chair/trolley based treatment or complex diagnostics. We are aware of some overlap and are working with clinical leads and divisions on this.