How is same day emergency care (SDEC) being implemented across England?

Background: In 2019, the National Health Service (NHS) England announced the implementation of same day emergency care (SDEC) in every hospital with a type 1 emergency department (ED). SDEC aims to provide timely and appropriate specialist care to patients on the same day, expediting their investigations and avoiding unnecessary hospitalisation. 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.

Methods: 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 contextualise survey responses and explore perceptions of SDEC and subjective barriers to efficiency.

Results: 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. Referral and patient selection models varied. 79% of hospitals used their SDECs as emergency bed spaces. 85% of units assessed between 31 and 50 patients/day, with no unit admitting >10 patients/day. Although interviews were generally positive regarding SDEC efficiency, issues included differing perceptions of SDEC purpose, variability in models of patient selection, unclear referral pathways and inconsistent staffing levels.

Conclusions: Since its introduction, SDEC has been implemented and developed with great variability across England. While the introduction of the NHS SAMEDAY guidelines in 2024 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.