How same day emergency care helps patients avoid hospital stays

Same day emergency care (SDEC) provides specialist care for patients without the need for hospital admissions. The service, which opened in the Paterson wing at St Mary’s Hospital in December 2020, is part of a national initiative to help patients get the right care in the right place, first time. We caught up with members of the SDEC team to hear more about how this new service is helping patients who need urgent treatment to avoid unnecessary hospital stays – as well as offering challenging, interesting roles to staff.

Here matron Sarah Brown, senior sister Amy Hill, Dr Gareth Thompson and administrator Lee Phillips tell us more.

The SDEC at St Mary’s opened in December 2020. Before the pandemic, how would you describe what same day emergency care is?

Sarah: “Same day emergency care (SDEC) is essentially an evolution of ambulatory emergency care and means we’re able to provide urgent care to patients on an outpatient basis – so without the need for an overnight stay.

“Patients are referred to us from emergency departments or directly from their GP. I run the service alongside emergency medicine consultant and head of specialty, Lucy Bingham. We also work closely with the ambulatory emergency care service at Charing Cross Hospital.

“The service has been growing ever since we opened at the end of December last year and we’re now four times the size we were. In fact, we now have 26 per cent more patients than we did when operating our former ambulatory care service. Our team has expanded to include more doctors, nurses, healthcare assistants, receptionists, and advanced clinical practitioners who together treat patients and discharge them in one day, or over multiple visits. It’s a diverse team with a great mix of skills and experience to accommodate different patients’ needs.

Who can be referred to SDEC?

Amy: “Our A&E ‘front door’ is extremely busy, so SDEC supports this by taking referrals directly from A&E, from GPs or from specialists within our hospitals. There are 12 SDEC pathways but we now consider any patient who meets the unit’s criteria – we encourage clinicians to call us to discuss individual patients so we can advise where the best place is for them to go.”

Gareth: “Our patients have medical complaints, not injuries. For example, someone might come to us with cellulitis in their arm that requires urgent antibiotics. We work with our OPAT service  to offer them IV antibiotics without them needing a bed in hospital and send them home by the evening. They may need additional IV antibiotics over the next few days – we can arrange for them to come in during the next day or two, have treatment, and leave. Previously, they might have been admitted and taken up a bed for what was effectively a few hours of treatment each day.”

Sarah: “Patients who come to A&E with severe headaches, dizziness and limb numbness can end up admitted to hospital under medical teams, waiting for specialist neurologist input and investigations on the wards. These investigations can take several days. We now have two locum consultant neurologists in SDEC who offer specialist advice and treatment for symptoms like those, so patients can see a neurologist urgently and go home the same day. The neurologists can also identify patients who have already been admitted, see them in our department, and send them home if appropriate.

“We don’t have dedicated specialist consultant coverage for other specialties at the moment, but we often have visiting teams from gastroenterology, infectious diseases, dermatology, hepatology and rheumatology come to us to see patients when required, which is helpful.”

How does SDEC make a difference to patients?

Gareth: “We see up to 60 patients in our 12-hour day. Most of those patients would otherwise have been waiting in A&E or admitted to an inpatient bed, so we’re able to act as a pressure valve for the hospital. We also get to create full treatment plans and see the whole patient pathway. I’ve spent most of my career in A&E, so it's very satisfying to now be in a position where I can see patients throughout their treatment journey.”

What do you like about working in this environment?

Lee: “I have worked in many different environments across the public sector and working in SDEC has been a highlight. It’s an interesting environment and I’ve absorbed a lot, particularly on the medical side of things. It’s also rewarding, particularly as we treat patients same day – you may see someone hobbling in in the morning and leaving with a spring in their step in the afternoon.”

“I think SDEC works because of the close-knit team. Everyone here is very professional and here to provide the best care for patients. Plus, the staff also take the time to look after each other, as well as the patients. If staff notice you’re having a bad day, they’ll phone you after work just to check in and say, ‘You were a bit quiet today, how are you feeling?’ It makes all the difference knowing your colleagues care about you as a person.”

Amy: “The resilience of the team has been incredible, not only during the challenges of the pandemic, but the uncertainty of the relocation from the Queen Elizabeth the Queen Mother building – allowing our expansion of service and new way of working. The urgent and emergency medicine team have stood by us, had faith and appreciated that we have made a change that will benefit them, but most importantly, benefit the patients. I am really proud of the whole team.”

What’s next for SDEC?

Sarah: “We have great plans – with more staff, we may be able to run consultant-led emergency clinics and offer supported discharge to help wards send patients home more quickly. We’re now able to receive referrals direct from NHS 111 and are working towards this from the London Ambulance Service. Our paediatric SDEC team have now joined us in at St Mary’s Hospital too, allowing for closer working and collaboration. We’re proud to help improve patient flow throughout our hospitals.