Urgent same day care to spare half a million more patients unnecessary hospital stays as part of NHS Long Term Plan
Every major hospital will provide urgent same day services to improve care for patients and cut unnecessary admissions by next winter, NHS National Medical Director Professor Stephen Powis said recently (08 March 2019).
Many hospitals are already providing comprehensive care without admitting patients who come to A&E with conditions such as pneumonia or other breathing difficulties through same day emergency care (SDEC) services, which are also known as ambulatory care.
SDEC services can prevent patients deteriorating from unnecessary or long stays in hospital, free up beds in hospital wards, and improve the flow of patients through A&E – allowing doctors and nurses to focus on those who need the most urgent care.
But clinical leaders believe that around half a million more patients a year across England could be assessed, diagnosed, treated and allowed to return home without the need for an overnight stay.
And from Spring, local pilots will test how new NHS standards for urgent and emergency care could support the ambition to ensure patients across the country benefit from this service, with hospitals to be measured on their success in reducing overnight admissions.
Professor Stephen Powis, national medical director for the NHS in England, recently said:
“For seriously ill people a hospital stay is often unavoidable, but we know that too many people – particularly the frail and elderly – are ending up trapped on wards for days on end.
“With modern technology we can now offer many more ill patients access to new rapid tests and optimal treatments from senior doctors all in the same day and avoid admission. That’s more convenient for our patients, and more efficient for the NHS.
“That’s why the NHS Long Term Plan will make sure that more people every year get the right care fast, meaning they could be safely back at home on the same day, and at the same time more hospital beds can be freed up for those who need them most.”
As part of the NHS Long Term Plan, all hospitals which have a full Emergency Department will be required to step up efforts to ensure that they provide this service, with the aim of a third of patients who require an emergency admission being able to return home the same day, up from a fifth currently.
An early pioneer, South Tees Hospital NHS Foundation Trust increased the proportion of same day discharge from 6% to 40% over the three years to 2012, and to 50% by 2015, with the Trust believing these increases are largely down to the introduction of same day emergency care.
SDEC teams can bring together a range of different professionals and specialists depending on the needs of local people, including acute physicians, specialist DVT nurses, physios and geriatricians.
Dr Nick Scriven, President of the Society of Acute Medicine, recently said:
“Same Day Emergency Care is an essential part of emergency and urgent care for individuals in that it avoids admission overnight into a hospital bed with all the risks and hazards that entails for conditions that can be treated equally as effectively with the patient benefiting from returning to their own bed overnight.
“Acute Medicine specialists provide a large proportion of this type of service and in our recent benchmarking survey (SAMBA) on average just over 20% of patients presenting for urgent medical care were seen in this setting, with over 80% being discharged on the same day.”
The full adoption of SDEC services is part of a raft of measures set out in the NHS Long Term Plan which will help ensure that people with urgent care needs get the right help in the right place, and reduce pressure on A&Es.
Ambulance services, out-of-hours GPs and Urgent Treatment Centres will also work more closely together as part of a 24/7 Integrated Urgent Care Service, which patients will be able to access through the NHS111 phone line or online service.
At the heart of the new service will be teams made up by a range of different professionals, covering both physical and mental health, who will be able to provide specialist advice, assessments and referrals to the most appropriate service.
These teams will have access to a patient’s digital medical records, and be able to provide advice to other professionals such as ambulance crews, social care workers and community nurses, to ensure that the best decisions are made about the care an individual needs.
At the request of the Prime Minister, the NHS is also undertaking a clinically-led review of how current measures – including the four hour A&E standard, introduced 15 years ago – could be improved to ensure they measure what matters most to patients, reflect significant advances in how services are delivered, including same day emergency care, and support NHS staff to deliver the best quality care possible, particularly for those patients with the most critical health needs.
The review, being conducted by top doctors, nurses and hospital bosses, is expected to present full recommendations for trials in Spring, which if successful will be adopted fully in time for next winter, but these will include a measurement for how well hospitals are able to avoid overnight emergency admissions.
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