Half of same day emergency care units ‘impaired

The Society for Acute Medicine has claimed that almost half of units set-up across the NHS to deliver same day emergency care have been ‘impaired’ due to pressures on hospitals for extra beds.

The audit showed that 45 per cent of same day emergency care (SDEC) units, previously known as ambulatory emergency care, had ‘functioning impaired’ by hospital trusts utilising the space as overflow for admitted patients.

The Society for Acute Medicine said that the development was at risk of becoming known as a ‘default overflow’ for patients in need of admission - devaluing its purpose.

The service, which sits within acute medical units, offers an alternative to hospital admission for patients with serious medical problems who might otherwise have spent at least one night in a hospital bed.
There are around 20 conditions, such as life-threatening blood clots (deep vein thrombosis), dislodged blood clots (pulmonary embolism), cellulitis, seizures and anaemia, suitable for treatment in this outpatient-based setting.

In a report released last year, it was revealed that 977 overnight admissions were prevented on one day by the use of SDEC and estimated that just a five per cent increase in the number of patients who received their first assessment and subsequent treatment there could prevent more than 14,000 overnight admissions over the crucial winter months of January and February.

As a result of this work, SDEC was incorporated into the NHS Long Term Plan and, in March, NHS England announced every major hospital would provide same day emergency care services by this winter.

The recent annual Society for Acute Medicine Benchmarking Audit (SAMBA) reviewed the performance of 141 acute medical units and 7,170 patients over a 24-hour period in June. Although 96 per cent of units confirmed they had some form of SDEC in place, only 22 per cent of patients received their first assessment there - lower than the 30 per cent target set by NHS England.

Dr Scriven, president of the Society for Acute Medicine, said: “The SDEC units, despite designed to alleviate pressure, are actually victim of it themselves, with 45 per cent having had their functioning impaired by the need for trusts to put beds in these areas to cope with demand for admissions. And we have to remember this audit was carried out in June when we should see pressures on capacity relent slightly from the intensity of winter.

“This is, of course, a vicious cycle as impaired SDEC means more admissions, so unless we are able to protect these units and ensure they are properly resourced, they will represent a huge missed opportunity for the NHS to manage ever-increasing pressures.”

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