Same day care. The right patient. The right specialist team.
Same Day Emergency Care (SDEC) enables patients with urgent healthcare needs, who would otherwise require hospital admission, to receive specialist assessment, investigation and treatment without an overnight stay when clinically appropriate.
Medical SDEC is a core part of Acute Medicine. It requires timely senior decision-making, appropriate patient selection, diagnostic access and a multidisciplinary team. The aim is to avoid an unnecessary admission — not simply to move patients out of the Emergency Department.
NHS England's SDEC explainer animation. The video describes the wider model; SAM's guidance below explains the role of medical SDEC.
Understanding medical SDEC
SDEC builds on the long-established ambulatory emergency care model. It is an approach to providing acute care, rather than simply a physical location.
What medical SDEC is
- Specialist Acute Medicine care for people with an acute medical problem and a meaningful likelihood of admission.
- Rapid clinical assessment, appropriate diagnostics, treatment and decision-making.
- Care delivered by an appropriately staffed and clinically governed multidisciplinary team.
- Same-day discharge when safe, sometimes followed by planned review as part of an agreed care pathway.
What medical SDEC is not
- A waiting area for investigations or transport.
- A short-stay ward, overflow area or substitute inpatient bed.
- A default destination for undifferentiated ED patients without appropriate clinical assessment.
- A performance workaround to meet time-based targets.
- An outpatient clinic for treatment that does not require urgent specialist care.
GP, ambulance, ED, community or acute medical take
Assessment, differentiation, risk stratification and suitability
Senior review, investigations and treatment under Acute Medicine governance
Home with clear safety-netting and follow-up, or admission when needed
This is an illustrative clinical pathway, not a replacement for local referral criteria or escalation protocols.
SAM's position on SDEC
Our guidance has evolved with service delivery and national policy. The most recent position should lead, with earlier statements retained as an accessible policy history.
Clarifying the difference between EEMAC and Medical SDEC
Sets out why these are different clinical models, with distinct specialty governance, patient selection, workforce and reporting. Emphasises that medical SDEC should remain a genuine admission-avoidance service.
Read position statement (PDF) →SDEC: A need to pause and reset!
Six recommendations on clinically led patient selection, diagnostic access, protecting SDEC capacity, safe follow-up and zero tolerance of routine bedding.
Read Pause and Reset (PDF) →Medical SDEC and EEMAC: complementary, not interchangeable
Medical Same Day Emergency Care and Extended Emergency Medicine Ambulatory Care (EEMAC) can work closely together, but must retain clear clinical ownership and appropriate patient selection.
| Principle | Medical SDEC | EEMAC |
|---|---|---|
| Clinical model | Specialist Acute Medicine, principally admission avoidance | Extended ambulatory management of selected ED patients |
| Clinical responsibility | Acute Medicine team and governance | Emergency Medicine team and governance |
| Patient selection | Acute medical needs, meaningful admission risk, suitable for same-day care | Selected differentiated and risk-stratified ED patients suitable for ongoing ambulatory ED care |
| Access | Clinically governed referral and active selection, including from outside ED | Appropriate ED assessment and referral under Emergency Medicine pathways |
| Reporting in England | Specialty SDEC in APC under NHS England's updated guidance | Emergency Medicine ambulatory activity remains within ECDS |
Co-location does not make the services interchangeable. Where they share a footprint, governance, inclusion criteria, responsibility, communication and activity reporting still need to be distinct.
SDEC across the four nations
Explore the national frameworks, implementation guidance and data standards relevant to each health service. Terminology and national reporting arrangements differ across the UK.
England
NHS England · SAMEDAY and national delivery guidance
The SAMEDAY framework sets out the design and delivery of SDEC, supported by a service specification, acute pathway standards and practical referral guidance.
SAMEDAY strategy and framework → SDEC service specification (updated 2026) → Model Acute Pathway (2026) → Access and direct referral to SDEC →Wales · Cymru
NHS Wales Executive · UNDIWRNOD strategy
The Welsh UNDIWRNOD strategy adapts the principles of SAMEDAY to Wales and outlines nine national SDEC service priorities.
UNDIWRNOD SDEC strategy (Dec 2024, PDF) → All-Wales direct paramedic referral policy → NHS Wales urgent and emergency care programme → WECDS guidance and documentation →Scotland
Scottish Government / NHS Scotland · Rapid Assessment and Care
Scotland's evolving same-day approach includes Rapid Assessment and Care (RAC) and rapid acute assessment and discharge. The national flow plan supports expansion of SDEC.
Health and Care Improving Flow Plan 2026–2031 → High Impact Change 5: rapid acute assessment and discharge → Admission alternative pathways / reporting review → Urgent and Unscheduled Care Collaborative →Northern Ireland
Department of Health / HSC · Urgent and ambulatory care pathways
Regional urgent and emergency care policy supports ambulatory models, with SDEC services and pathway development progressing at HSC Trust level.
Review of Urgent and Emergency Care Services → No More Silos action plan → Northern Trust SDEC delivery example (2026/27) → Ambulatory care example: Causeway Hospital →Delivering safe, effective medical SDEC
Six service design principles informed by SAM policy, RCPE/SAM standards and national frameworks. These are prompts for local quality assurance rather than a substitute for a full service specification.
Choose the right patients
Agreed referral criteria, appropriate clinical assessment, risk stratification and Acute Medicine ownership of admission-avoidance selection.
Enable senior decisions
Consistent consultant-level input, skilled nursing and MDT staffing, training capacity and clear specialty accountability.
Remove unnecessary delays
Timely imaging, laboratory investigations, treatments and referral access that support genuine same-day decision-making.
Keep SDEC non-bedded
Prevent routine use as an overflow ward, inpatient holding area or ED waiting space; escalation must protect SDEC throughput.
Plan safe onward care
Clear discharge summaries, safety-netting, clinical escalation and planned follow-up where part of the specialist acute pathway.
Measure meaningful outcomes
Monitor case mix, direct referrals, conversion to admission, time to care, reattendance, patient experience and bedding.
Coding, counting and reporting SDEC
Accurate reporting must distinguish clinical specialty, episode type and the care actually delivered. Older documents may describe superseded arrangements, so always use the most recent guidance for the relevant nation.
Specialty SDEC reporting is moving to the APC dataset
NHS England's guidance of 6 August 2026 requires hospitals to report defined specialty SDEC activity through Admitted Patient Care (APC). Emergency Medicine ambulatory care (EEMAC) remains within ECDS. Organisations must comply by 1 April 2027 and should implement changes as soon as possible.
Read official specialty SDEC reporting guidance →What should local SDEC teams count?
For service improvement, track referral source, patient selection, specialty attribution, same-day discharge, conversion to overnight admission, length of stay, reattendance, patient experience and any overnight bedding. These local quality measures are not a replacement for nationally mandated submissions.
Clinical pathways and practical resources
Specialty guidance can support carefully selected patients in SDEC. Decisions must still follow each document's inclusion and exclusion criteria and local clinical governance.
Measure, improve and share
Effective SDEC should demonstrate clinical benefit, patient experience and contribution to admission avoidance, rather than measuring throughput alone.