SAMEDAY strategy

A framework for the development and delivery of same day emergency care.


This SAMEDAY strategy supports the delivery of same day emergency care (SDEC) across England in a standardised and consistent way.

As stated in the Delivery plan for recovering urgent and emergency care services, the ambition is for a SDEC service to be in place across every hospital with a Type I emergency department (ED).  The SAMEDAY strategy aspires to support the delivery of SDEC across England. SDEC is one of the many ways the NHS (National Health Service) is working to provide the right care, in the right place, at the right time for patients in a standardised and consistent way so that patients are not admitted when it is not clinically appropriate.

SDEC allows specialists, where appropriate, to assess, diagnose and treat patients on the same day of arrival who would otherwise have been admitted to hospital.

Some of the growth in admitted non-elective activity over the past decade has been for patients who spend 1 or 2 days in hospital; many could be safely and effectively managed using a same day approach. This involves ensuring the working patterns of senior clinicians support early clinical review, decision-making, treatment and rapid access to diagnostic services, including point of care testing. Clear processes from referral to arrival also support early decision-making and maximise the opportunity to complete patient care within the same day.

SDEC is not an outpatient service as new treatment strategies, technology and investigations enable SDEC to deliver the same benefits as inpatient care, while reducing the risk of nosocomial infection and deconditioning, reducing delays in the emergency patient pathway and pressure on the system as a whole. It also improves patient and staff satisfaction.

We need to reduce variation in care and ensure greater consistency in direct referrals to specialist care such as older people living with frailty to better respond to the needs of vulnerable patients at increased risk of admission. The delivery priorities set out in the Urgent and emergency care (UEC) recovery plan are linked to 10 high impact improvements that highlight areas where system transformation is an imperative, currently being delivered through the universal support offer (USO). The purpose of the USO is to support system leaders to undertake improvement projects to support transformation at a local level.

The SDEC service approach should also make connections across UEC to improve patient flow. For example, paramedics should be able to directly refer patients to SDEC, where appropriate, ideally via a single point of access (SPOA) to provide a single, simple route for referral to hospital.

System leadership is crucial to the impact SDEC can have on reducing the number of beds occupied by unnecessary emergency admissions, to expedite the admission of patients who do need to stay in hospital. Joint planning of SDEC across healthcare settings will improve patient flow between secondary, community and primary care settings following the completion of agreed treatment plans and will mean patients can be discharged to their usual place of residence, community setting or virtual ward for ongoing care where clinically appropriate to get the care they need safely and conveniently without delay.

We are keen to continue to develop and improve this document so that system leaders, clinicians and operational staff can best meet the needs of patients and the public. If you have any feedback, require further information or support, please contact the In-Hospital Care (non-admitted pathways) team at:

7 SDEC service priorities

The SAMEDAY strategy has 7 priorities: 

  • Staffing is safe and sustainable
  • Access is integrated system wide
  • Monitoring and evaluation identify, define and report patients suitable for same day care
  • Estate is maximised across the healthcare system
  • Diagnostics and testing capacity support rapid access to same day services
  • Alternative to admission supports patients to be discharged on the same day to their usual place of residence
  • You have the opportunity to facilitate change by developing a culture of visible leadership

The aim of each priority is stated below, along with recommendations for how the improvement, transformation and integration of each aim will be achieved, and our commitment to providers is outlined alongside the recommendations for providers and healthcare systems.

1. Staffing

A multiprofessional workforce is required to deliver SDEC and every SDEC service should determine its local requirements to meet patient demand.

Staff must be trained in and be competent to undertake the tasks needed to deliver SDEC, and have the opportunity to gain further skills and competencies to expand their existing job roles, learn and develop.

Staff roles

SDEC is often best delivered by a workforce that includes the following roles:

  • consultants, GPs with extended roles (GPwER), specialist and associate specialist doctors, and doctors in training (emergency, general, acute and single organ specialists)
  • nurses (registered and un-registered), allied health professionals (AHPs) (including consultants), advanced clinical practitioners (ACPs) and physician associates (PAs)
  • administrative, clerical and housekeeping staff
  • service managers and operational staff

Access to other staff such as porters, pharmacists and radiographers will also be important, and links should be established with social care staff to facilitate extra support for patients discharged home as required.

Senior clinical decision-maker

A key requirement is having an identified senior clinical decision-maker on duty in SDEC during opening hours. They should be available as early in the patient journey as possible to ensure that patients are directed to the right service at the right time.

Senior clinical decision-makers can and should be from across the healthcare professional groups. They need:

  • excellent clinical assessment skills
  • rapid decision-making skills using limited clinical information
  • excellent interpersonal skills to challenge admission and referral decisions
  • detailed knowledge of SDEC service resources and capabilities
  • knowledge of the alternative pathways to admission and how to access them (ideally supported by a single point of access/Directory of Services (DoS)
  • authority to request diagnostics
  • authority to act on their judgement
  • ability to independently manage the entire patient journey, including discharge

We are working with Royal Colleges and their constituent societies to agree a standardised definition of, and competencies required to be, a senior clinical decision-maker for SDEC.

Staffing allocation

Appropriate staffing should be provided to operate SDEC services on a sustainable basis for a minimum of 12 hours a day, 7 days a week, and with acute frailty services operating for 70 hours a week during peak demand hours.

SDEC services should review activity levels during opening hours to quantify demand on the service, including the times when this is highest and lowest. This should be reviewed across 24 hours as opposed to the opening hours of the service to identify where peak demand times are. Staffing models should match these fluctuations, which may mean a move away from traditional shift patterns to meet 7-day service provision. Any changes to working patterns must consider work–life balance for staff.

Staff should be assigned to SDEC to ensure delivery of a consistent service offer and continuity of care. This is often easier to do for nursing and AHP staff than medical staff who will often be part of an on-call rota. Ad-hoc in-reach into SDEC by specialty doctors may be required, and providers should have robust inter-professional standards to support this. However, for specialties such as acute medicine, frailty, emergency and general surgery, a designated workforce based in the SDEC unit service is beneficial to manage unplanned demand.

Staffing resources

Resources are available to identify staffing requirements including number of staff to support the operational delivery of SDEC services and skills and competency staff require to work in the SDEC setting.

Demand and capacity tools

NHS England’s Emergency Care Improvement Support Team (ECIST) have developed an MS Excel demand and capacity tool to look at current and future workforce SDEC requirements for nursing and medical staff.

Workforce modelling tool

Former Health Education England developed a workforce modelling tool has been adapted to support SDEC services to optimise their skill mix.

SDEC task and skillset framework

This SDEC task and skill set framework supports SDEC services in reviewing their staffing models.

2. Access

All providers across the healthcare system including NHS 111, 999, primary care, community care and mental health services, should have access to same day services.

Patients suitable for an SDEC model of care should be identified by asking:

  • would this patient otherwise be admitted to a hospital bed?
  • is the patient sufficiently clinically stable to be managed in SDEC?
  • is the patient sufficiently functionally stable to be managed in SDEC?
  • is there an alternative non-admitted pathway that could more appropriately manage the patient?

Access criteria

Providers should adopt a standard approach to deciding exclusion criteria for SDEC referrals using this SDEC inclusion and exclusion criteria guidance developed by clinicians across the country, so that clinical red flags are ruled out and SDEC is considered as a credible alternative.

SDEC should be intrinsically linked to other services that operate to keep patients at home or reduce their length of stay in hospital such as urgent community response (UCR). Single point of access (SPoA) services should also be considered as part of aligning access, allowing clinical discussion and enabling early intervention. SDEC can also support patients to be cared for through virtual wards either as a continuation of care or post discharge.

Direct referral

Direct referral to SDEC should be available system wide to allow early identification of appropriate patients and help reduce clinical touchpoints, unnecessary triage, multiple handovers of care and history giving, ED crowding and avoidable ambulance conveyances.

Developing direct access criteria (and minimal exclusion criteria) will standardise high-volume pathways to reduce variability and support patient access to SDEC/acute frailty services.

Before referring, clinicians should be able to speak to a specialist clinician for pre-referral advice and guidance over the telephone, using a direct dial in number.

The ambulance service where appropriate should be able to convey patients directly to SDEC services, reducing handover times and helping to protect resource for those patients with life-limiting or life-threatening illness or injury. Ambulance clinicians should be able to contact the senior clinical decision-maker in SDEC to agree where a patient is best reviewed and treated.

Please refer to the national guidance for ambulance clinicians to refer into SDEC for more information on direct referral (on the FutureNHS collaboration platform; access will need to be requested).

Directory of Services (DoS)

SDEC services should be profiled in the DoS. NHS 111 and 999 services as well as primary and community care clinicians use this directory as well as Service Finder and MiDoS (mobile DoS).

While some providers will use other tools to profile their services, the approach to profiling SDEC services should be standardised across each integrated care system or regional footprint, including opening times (when referrals are accepted), exclusion criteria, how to refer a patient and direct dial contact numbers. Referral information should also include appropriate cut-off referral times to avoid referring a patient after service closure.

A regular comprehensive review of the DoS will support increased referrals supported by a digital direct referral to the provider.

3. Monitoring and evaluation

A system-wide approach is needed for recording same day activity so that it can be counted and reported consistently. The current mechanism of counting SDEC is based on zero-day length of stay (0 LoS). This proxy measure has limitations, not least the inability to demonstrate the true impact of SDEC on improving patient flow across urgent and emergency care. A national pilot of recording SDEC activity on the Emergency Care Data Set (ECDS) has shown this allows better analysis of SDEC-related activity to enable effective data-informed decisions on service provision.

Access to timely and accurate data supports:

  • effective clinical decision-making
  • national benchmarking to demonstrate best practice and set national standards and principles to improve patient outcomes and experience of care
  • improved identification of health inequality and associated longer lengths of stay
  • productivity by delivering care in the most appropriate clinical setting.

3.1 Emergency Care Data Set (ECDS)

With all UEC activity to be recorded in ECDS (version 4) by April 2024, this will  be the single source of comprehensive, accurate and timely data for EDs, urgent treatment centres (UTCs), ambulance services (999) and other urgent care services (such as SDEC) in England.

High quality, complete and timely ECDS data submissions will enable informed, proactive decisions about service commissioning and operational planning at both local and national level that best meet patient need and demand.

The following guidance (on the FutureNHS collaboration platform) supports these submissions:

Summary Hospital Level Mortality Indicator (SHMI)

How ECDS interacts with tariffs for SDEC services and what impact moving this activity out of the Admitted Patient Care (APC) dataset into EDCS will have on the Summary Hospital-level Mortality Indicator is described in this guidance for recording SDEC activity into ECDS.

3.2 SDEC dashboard

The SDEC dashboard (on the FutureNHS collaboration platform) has been developed and is intended for use by local providers that submit Type 5 UEC activity. It refers to this activity as SDEC or Type 5 interchangeably.

It is not a performance monitoring tool, but intended primarily for use at local level, allowing providers to access their SDEC data in ECDS submissions. This data is useful to multiple teams including clinical, operational and business intelligence teams.

SDEC index

Selecting the right patients for SDEC is essential to maintain safety and maximise the impact on urgent and emergency flow. Many organisations have asked for support in identifying the clinical conditions that could best be managed via their SDEC services.

The SDEC index supports organisations to do this by identifying the highest impact conditions that are suitable for SDEC; these will vary by organisation. It has been developed to describe priority conditions, although this is not exhaustive (does not cover every condition that could be managed in SDEC) or exclusive (no condition that is not listed is ruled out). The list is designed to support organisations to identify the highest impact conditions and these will vary between organisations. Several caveats to this index should be noted, including the patient’s acuity on attendance, availability of diagnostics, agreed patient pathways in place and local guidelines. All of these are relevant to the decision about whether a patient is best diagnosed and managed within an SDEC service.

The SDEC index can be used in conjunction with the surgical, medical alternative route tool (SMART).

Measurement resource

We have developed the following measurement resource with the Society for Acute Medicine (SAM), Royal College of Physicians (RCP) and NHS England’s Getting it Right First Time (GIRFT) Programme.

1. The time spent in the ED or UTC prior to transfer to an SDEC facility should be kept to a minimum. The patient should be transferred within 60 minutes of the patient arriving in ED or UTC.

2. Activity in SDEC must be protected, including during periods of escalation when the hospital is under pressure. Loss of this activity will likely increase pressure.

3. Waiting times for patients in SDEC should be minimised.

  • observations contributing to a NEWS2 score (National Early Warning Score version 2 – a system to standardise response to acute illness) should be obtained within 15 minutes of a patient’s arrival.
  • patients should be seen promptly and within 60 minutes by a clinician who has the capabilities to assess and investigate their signs and symptoms.

4. A discharge summary should be written and sent on the day the episode of care is completed. This should detail the investigations undertaken, any new therapies instigated and the follow-up plan.

If there are multiple attendances, then the primary care team should receive regular communication, with the mechanism and content defined locally.

For all attendances, completion of the SDEC episode should be clearly communicated and management transferred back to the care team in the community.

5. No patient should stay in the SDEC service longer than 8 hours.

The following metrics should be collected and submitted to the ECDS to support the standardisation of delivery of SDEC services.

1. Monthly review of activity and performance within SDEC should include:

  • number of patients counted as SDEC activity
  • average length of stay (LoS) of a patient within the SDEC service
  • a review of patients who were admitted to a base specialty ward but had a 0 day or 1-day LoS, with the view to identifying if the patient was a missed opportunity for SDEC
  • conversion rates to admission between 20% and 30% of the activity seen in SDEC.

2. The number of SDEC attendances as a proportion of the whole UEC site activity. The SDEC registry (evaluation tool) should be referred to, ensuring that the patient is recognised as having an SDEC appropriate condition.

3. The total time from the patient arriving at the hospital (that is, ED or direct to SDEC) to discharge to their usual place of residence or admission to a specialty ward.

4. The number of SDEC attendances referred via ED, UTC, 999/NHS 111/primary/community and mental healthcare providers.

5. Discharge destination: home, continuity of care in the community, on a virtual ward/hospital, admission to a bed, outpatient appointment, hot clinic appointment, cancer pathway.

6. For ED/UTC patients: time in department (ED/UTC) prior to arrival in SDEC.

7. The number of unplanned re-presentations of patients who had been managed by an SDEC service within the previous 7 days.

Experience of care

It is important to collect accurate and timely data to evaluate patient experience of SDEC. From stakeholder engagement we have developed 10 quality markers (on the FutureNHS collaboration platform)  for the evaluation of patient experience across SDEC. These help SDEC services reflect on the care they deliver from the patient’s perspective and identify how they can continually improve. They are not specific questions to ask patients using SDEC services; instead, they are intended to help SDEC services consider how they are delivering care to support continual improvement.

The quality markers are:

  1. People referred to SDEC know what to expect from SDEC before they arrive (for example, clear directions, car parking and general facilities, eating and drinking, what the service provides and why they have been referred to it).
  2. People using SDEC are greeted when they arrive to make sure they know what is happening and understand what SDEC is.
  3. People using SDEC feel cared for, and we ask what matters most to them – making this a priority in their care.
  4. People using SDEC are given the opportunity to ask any questions they have and are provided with regular updates.
  5. People using SDEC know the name and role of the person providing support and are assured they are being seen by the right person, at the right time.
  6. Staff are supported to offer the best care they can. We ask our staff what matters most to them – and directly involve them in service design and delivery.
  7. People using SDEC know what to do when they leave the service and who to contact if they have any questions or concerns.
  8. People are seen in the right place by the right person. SDEC teams connect with and inform other local services and referral routes to support appropriate referrals to SDEC.
  9. Feedback from staff and people using SDEC is welcomed, encouraged, valued and collected.
  10. Feedback and ideas from staff and people who use SDEC is used to co-produce service and quality improvements.

4. Estates

Ideally SDEC services should be located close to an acute medical or surgical unit (AMU/ASU) to allow the quick transfer of suitable patients from these services to SDEC, but with its own external entrance for direct access. This external entrance also reduces the footfall through SDEC and makes it easier for patients to leave the hospital when they are discharged.

SDEC unit

The required SDEC estate, facilities and equipment will vary across healthcare settings in England.

A well-designed SDEC unit will minimise patient delays as they move through stages of care. Good patient flow through SDEC is central to patient experience, clinical safety and reducing pressure on staff and the system.

Health Building Note (HBN) 15-02 (2021) gives guidance on the planning and design of an SDEC department. Its core recommendations are:

  • where possible, SDEC should be close to a Type 1 ED. We acknowledge the estates challenges that trusts face and it will be for individual trusts to decide whether it is feasible to co-locate SDEC services.
  • acute frailty services are advocated as a flexible service that supports multiple specialties (ED, acute medicine, acute surgery).
  • SDEC should have a combination of consulting rooms, trolleys and chairs for patient assessment and treatment (fit to sit).
  • beds should never be provided in an SDEC unit as doing so could reduce patient flow.
  • key considerations when designing a unit include the need for a waiting room, consultation rooms, initial assessment area, procedure room, treatment area, phlebotomy space, medication and preparation area, reception, space to provide refreshments and generic workspaces.

Non-bedding of SDEC

The national benchmarking audit commissioned by NHS England in Autumn 2021 highlighted that 53.5% of acute hospitals frequently (multiple times a week) use their SDEC as an escalation area for inpatient beds. Bedding the SDEC estate reduces the number of patients the service can manage.

SDEC services should not be bedded or repurposed during periods of pressure; these services are particularly critical to patient flow when inpatient beds are limited.

Following a proof of concept project it was recognised that stopping the bedding of SDEC is a multifaceted problem. Suggestions to support trusts in ensuring SDEC spaces are not bedded can be found on the FutureNHS collaboration platform.

5. Diagnostics and testing

Patients should have direct and rapid access to diagnostics and investigation as standard over 7 days to support swift assessment and treatment, facilitating discharge on the same day. For this to happen diagnostics and testing capacity should support early review by senior decision-makers, rapid assessment and treatment facilitating discharge on the same day. Therefore, patients attending SDEC should have access to diagnostics within a similar timeframe as ED patients as standard.

SDEC providers should also review innovative technologies to support rapid diagnosis or monitoring of conditions that can present acutely. Consideration should be given to the development of point of care testing (POCT) to support rapid decision-making and management of patients.

Community diagnostic centres (CDCs) could be used to carry out tests ahead of a patient’s attendance where this is clinically appropriate and requested at the point of referral.

6. Alternatives to admission

Paramount in deciding a patient’s suitability for SDEC is their safety: is an admission to hospital or treatment in a same day environment safest for them? Part of ensuring patient safety is challenging the assumption that admitted care is the most appropriate environment for the patient. If a patient does not need ‘in hospital’ care, the senior decision-maker should consider an alternative clinical setting.

The local provider should set appropriate thresholds for the level of acuity of patients seen in SDEC, although clinical consensus suggests that patients should be deemed SDEC appropriate until ruled out. Some providers use the National Early Warning Score (NEWS2) of <5 as the threshold for medical patients. If deemed appropriate, the referring specialist should discuss patients who do not fit this criteria with a senior clinical decision-maker. All decisions on thresholds should be influenced by the wider care environment and the workforce model.

Patients with complex social and/or functional needs, including mental health, dementia and end of life patients must not to be excluded from SDEC as they are potentially very well served by a same day environment that avoids lengthy admissions and deconditioning, as well as disruption to any community-based care packages. Using SDEC rather than admission allows community-based care to continue without interruption when the patient needs a period of emergency assessment and intervention in secondary care. There are opportunities to use the flexibility of SDEC to manage older people living with frailty in a way that is planned, personal and less distressing for the patient.

Patient selection

Patient selection for SDEC works best when senior clinicians and the referring clinician discuss the patient’s clinical presentation, supported by tools such as NEWS2 and clinical history. For older patients living with frailty, a triple assessment approach that is based on the clinical guidance from both the NHS England guidance for emergency department initial assessment and British Geriatric Society (Silver Book) should be used: NEWS2, Clinical Frailty Score (CFS) and 4AT score (a screening instrument for rapid and sensitive initial assessment of cognitive impairment and delirium).

Patient selection for SDEC should be based on:

  • clinical stability: this is established by recording a NEWS2 score to support clinical discussion.
  • SDEC being the best place to meet the patient’s clinical needs.
  • SDEC staffing and facilities being appropriate to meet the patient’s functional needs and maintain their privacy and dignity.
  • SDEC being able to treat, manage and discharge the patient to their usual place of residence on the same day.
  • patient’s needs cannot be met by primary or community health services.

To avoid inappropriate referrals to SDEC, a clear process for patient selection and a robust gatekeeping system are needed. Referral acceptance should be based on agreed pathways and/or clinical exclusion criteria, not individual clinician thresholds.

Patients who should not be managed in an SDEC service are:

  • outpatients.
  • patients needing the facilities of a discharge lounge.
  • patients waiting to be admitted to a hospital bed.
  • clinically unstable patients; for example, NEWS2 >5 (unless clinically accepted).
  • patients overflowing from another service which does not have the capacity to manage its own care.

SDEC services are one part of the UEC system, and it is important that patients access the most appropriate service for their needs. Another service within UEC such as UCR may be more appropriate for the patient.

Some patients initially identified as suitable for SDEC may require admission following investigation and review by the SDEC team. This should not be seen as a failure but the right course of action for the patient following review. The overall conversion rate of SDEC patients to admitted patients should be monitored and reviewed; a rate of 20–30% should be expected.

Trusts should also monitor (as outlined under priority 3) and review the number of patients who attend ED and then have a 1 or 2-day LoS, to identify opportunities missed for referral to the SDEC service.

Effective patient streaming

Multiple and duplicated assessments before the patient presents at SDEC must be avoided. Patients should be identified as suitable for streaming to SDEC as early in their journey as possible to reduce the risk of this. Direct referral to SDEC will help with this.

Patients with complex social and/or functional needs must not be excluded from SDEC. This group are potentially very well served by SDEC and acute frailty services (AFS), and same day care can avoid delay related harm, lengthy admissions and deconditioning as well as disruption to any community-based care packages.

Acute frailty service (AFS)

People living with frailty have reduced resilience to illness and are at increased risk of adverse health outcomes. SDEC services incorporating AFS can often manage older people living with frailty in a way that is planned, personal and much less distressing for the person concerned.

The NHS Long Term Plan states that every acute hospital with a Type 1 ED will provide an AFS for at least 70 hours a week, that aims to complete a clinical frailty assessment within 30 minutes of arrival in the ED/SDEC unit. During winter 2022/23, an AFS pilot was undertaken to test this model and the findings from the pilot can be found on the Future NHS collaboration platform as well as improvement tools for all trusts to use to develop and/or enhance AFS in their healthcare setting via SDEC.

In many areas of the country a large proportion of people attending ED are over 65 and have higher likelihood of presenting with frailty; this requires early recognition and the patient to be in the right place for treatment, at the right time. Poor or late recognition of frailty or its associated syndromes increases the likelihood the patient will be admitted to hospital, have a longer length of stay in hospital, and generally experience poor long-term health outcomes.

Early identification of frailty prompts clinical decisions that lead to better care and treatment for best outcomes, along with the development of shared plans for anticipated future illness or events.

An AFS is not a standalone unit or team; it is an integrated approach involving staff working in an ED and urgent care services. Depending on the local context, how the AFS is run will vary but it is essential purpose and principles are constant.

We have developed SDEC acute frailty principles and characteristics and a frail strategy to support service delivery. This strategy works alongside the SAMEDAY strategy and emphasises that frailty is everyone’s business, not solely the responsibility of the AFS.

Specialty SDEC

While the requirements to deliver SDEC will be similar across most medical and surgical SDEC services, some specialty-specific elements will need to be considered. To support this, we have produced or are developing SDEC guides for:

  • Surgical SDEC (on the FutureNHS collaboration platform): surgical SDEC services can be standalone units or co-located with medical SDEC services. This guide covers frailty.
  • Oncology SDEC: we are currently developing guidance with our oncology leads to support the delivery of this service.
  • Paediatric SDEC: we recognise that SDEC for children has existed for a long time and is already highly developed. We have developed this guidance with the Royal College of Paediatrics and Child Health, paediatrics clinical leads across the country and the NHS England Children and Young People’s Transformation team alongside this.

Virtual wards

Virtual wards support patients who would otherwise be in hospital to receive the acute care, remote monitoring and treatment they need in their own home or usual place of residence.

They are suitable for patients with a range of conditions that can be safely and effectively be managed and monitored at home. Many local areas have developed or are developing virtual wards for a range of conditions, including respiratory problems and COVID-19, heart failure, and acute exacerbations of a frailty-related condition, as well as paediatric virtual wards.

SDEC and virtual wards have similar objectives – where appropriate both avoid a patient’s admission to hospital, and the SDEC should collaborate with virtual ward/hospital teams to support patients (particularly those living with frailty) to remain at home where clinically appropriate.

7. You (culture and leadership)

SDEC should be promoted through strong clinical and executive leadership at organisational level to give all teams new perspectives on courageous leadership that will shape behaviours, and improve the quality and experience of care for patients. Clinicians, operational managers and system leaders need to understand the benefits SDEC brings for hospital capacity and flow, patients and their carers.

A successful SDEC model requires good relationships between all specialties including emergency medicine as well as primary care, community care and ambulance providers, diagnostics, and specialist service teams. Appropriate patient selection and access to a multidisciplinary team (MDT) of clinicians and diagnostics are key. 

Having an executive and a non-executive director sponsor and clinical lead for the SDEC service will champion the service’s development, ensuring that this model is part of core service delivery. The clinical lead should have dedicated time for the ongoing development of the SDEC service, working with operational colleagues.

Appendix: Self-assessment tools

We have produced two self-assessment tools for providers to benchmark themselves against.

Self-assessment tool: Current delivery

This tool helps you assess if your SDEC model meets the recommended minimum requirements.

Minimum requirement to be met for SDEC service


If no, see priority:

1. A named senior clinical decision-maker is on duty and present in SDEC during peak demand hours of operation, with access to an appropriate consultant to support decision-making as required.



2. SDEC service has its own dedicated workforce when open.


3. An agreed medical and nursing/AHP workforce template is used for SDEC service.


4. Access to a pharmacy service for patient medication advice, dispensing, supply and counselling of medication on discharge.


5. Referrers should be able to discuss referrals with an SDEC senior clinical decision-maker to ensure they are appropriate.



6. SDEC service is profiled in DoS with up-to-date opening times, referral criteria and contact details.


7. Primary care can refer patients directly to SDEC.


8. Ambulance clinicians can refer patients directly to SDEC.


9. Standardised referral/exclusion criteria are agreed and shared with healthcare partners.


10. Patients can be streamed direct from ED to SDEC.


11. NHS 111 services can refer patients directly to SDEC.


12. Community services (including UCR), virtual wards and SPoA services can refer patients directly to SDEC.


13. All SDEC activity is recorded via ECDS.



14. Sites have ceased recording SDEC activity on outpatient datasets (ODS).


15. SDEC service collects feedback from patients and identifies actions to improve patient experience.


16. SDEC should not be bedded to ensure continuous service provision.



17. Adequate waiting and treatment room/chair capacity should be available to meet demand.


18. SDEC unit should have a combination of consulting rooms, trolleys and chairs for patient assessment and treatment.


19. SDEC services should have the same access to diagnostics and reporting that ED has locally.



20. SDEC services must operate for a minimum of 12 hours a day, 7 days a week.



21. Acute frailty services must operate for a minimum of 70 hours a week.


22. Each SDEC service has a designated SDEC clinical lead who works in the service.



23. Each SDEC clinical lead should have designated professional activity sessions in their job plan to support the development of the SDEC (for example, development of polices and guidance, review of clinical practice, audits).


24. An executive director and a non-executive director are identified as sponsors for SDEC services.


Self-assessment tool: Opportunities for improvement

The tool helps you assess the potential to transform further and identify what you should be striving to achieve to improve your SDEC service model.

Improvement opportunities for your SDEC service


If no, see priority:

1. Workforce training and development plan is in place for all roles in SDEC.



2. Advanced level practice roles are embedded in the service model (for example, advanced clinical practitioners, nurse practitioners, clinical nurse specialists, clinical pharmacists).


3. SDEC staffing model supports unplanned demand using 0 LoS as a proxy measure for all patients.


4. A full MDT presence is embedded in the SDEC workforce model.


5. Referral criteria for SDEC are standardised across an ICS footprint.



6. Digital tools are considered as part of future planning to ensure ease of referral and sharing of patient information.


7. Booking tools are considered as part of future planning to ensure ease of referral and sharing of patient information.


8. Workforce boundaries are reduced by working across all areas of the ICS, maximising the opportunity to work across primary, community, mental health and secondary care.


9. All SDEC activity is recorded in ECDS as Type 5 activity.



10. SDEC services use the experience of care 10 quality markers to seek feedback from patients and from this identify any necessary changes to service provision.


11. Capital investment for SDEC estate is adequate to improve both physical and virtual capacity.



12. Demand and capacity modelling is undertaken to ensure that the SDEC footprint is fit for purpose.


13. SDEC unit has its own external entrance to support direct admissions to SDEC from ambulance services, walk-in, NHS 111, primary and community care.


14. SDEC services have access to community diagnostic centres to reduce pressure on acute diagnostic services.



15. SDEC services work across the community to support delivery of hospital@home.


16. SDEC services have access to POCT to facilitate prompt diagnosis and treatment of patients.


17. Streaming to SDEC avoids multiple assessments and duplication before the patient reaches the service.



18. Staff working in SDEC are involved in developing the service.



19. ICS leadership supports the provision of SDEC across primary, community, mental health and secondary care boundaries.


Publication reference: PRN00447