Abstract
Aims and Objectives In 2019, NHS England (NHSE) announced the implementation of Same Day Emergency Care Services (SDEC) in every hospital with a type 1 emergency department (ED). SDEC aims to provide timely and appropriate ambulatory care to patients on the same day, thus avoiding admission. There is limited evidence for SDEC adoption and its effectiveness. This mixed-method study identifies and analyses SDEC implementation methods and describes subjective workforce views through both surveys and interviews.
Method and Design An electronic survey was developed and distributed via email to 60 randomly selected hospitals in England with type 1 EDs. Follow-up interviews were conducted to expand on survey responses and identify key themes.
Results and Conclusion In total, 39 responses (including dual responses from SDEC and ED staff) were received from 34 hospitals (57%). All hospitals had an acute medical SDEC, with more limited implementation of surgical (53%) and frailty SDECs (29%). The SDECs opened on average 12 hours on weekdays and 10 hours on weekends. Although staffing models varied, a senior decision maker (consultant or registrar) was always present, with additional input from advanced clinical practitioners (ACPs) and physician associates (PAs), (85%). Availability of assessment spaces and IT resources was consistent, despite 79% of hospitals using their SDECs as emergency bed spaces. 85% of units assessed between 31-50 patients/day, with no unit admitting >10 patients per day. Although interviews were generally positive regarding SDEC efficiency, identified themes included variability in perceptions of SDEC purpose, issues with referral pathways and inconsistent staffing levels.
Since its introduction, SDEC has been implemented and developed with great variability across England, with a paucity of literature regarding its efficacy. While the introduction of the NHS SAMEDAY guidelines this year may assist in mitigating these discrepancies nationally, more research is vital to identify optimal methods of service delivery and evaluation of this new healthcare system.
