Half of same day emergency care units “impaired”

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.

An audit conducted by the Society for Acute Medicine (SAM) showed 45% 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.

Dr Nick Scriven, president of SAM, said 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, SAM found that 977 overnight admissions were prevented on one day by the use of SDEC and estimated that just a 5% 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.

In the recent annual Society for Acute Medicine Benchmarking Audit (SAMBA), which will be presented to members over the course of SAM’s two-day conference in Harrogate today (Thursday) and tomorrow, the organisation reviewed the performance of 141 acute medical units and 7,170 patients over a 24-hour period in June.

Although 96% of units confirmed they had some form of SDEC in place, only 22% of patients received their first assessment there – lower than the 30% target set by NHS England.

“The SDEC units, despite designed to alleviate pressure, are actually victim of it themselves, with 45% having had their functioning impaired by the need for trusts to put beds in these areas to cope with demand for admissions,” said Dr Scriven.

“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.”

He also said that, despite a pledge from NHS England to ensure SDEC was available in every major hospital this winter, little funding had been made available – resulting in some departments not running in evenings or at weekends.

In addition, he warned there was concern that trying to achieve SDEC was resulting in senior staff being “pulled” from other areas.

“The big stumbling block to getting this where we would all like it is not too hard to work out – staffing,” explained Dr Scriven.

“We highlighted this time last year the prospective benefits but all that has happened is the promise of money from somewhere to build new areas and buy some machines.

“As many other healthcare bodies have pointed out, this alone will not make things happen, you need the people and, so far, there has been little evidence of any actions following on from the launch of the people plan earlier this year.”