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Medics call for better use of same-day emergency clinics

Ambulatory emergency care could free 14,000 beds

Jo Carlowe

Wednesday, 21 November 2018

Senior medics warn the NHS is “on borrowed time” as winter approaches but say same-day emergency clinics could help.

In a report released today, Winter 2018/19 in the NHS: The solutions, the Society for Acute Medicine (SAM) calls on the government and NHS leaders to “realise urgently” the potential of ambulatory emergency care (AEC).

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 deep vein thrombosis, pulmonary embolism, cellulitis, seizures and anaemia, suitable for treatment in this outpatient-based setting.

In a recent audit, which covered 127 acute medical units and 6,114 patients over a 24-hour period in June, SAM found only 20.1% of patients received their first assessment in AEC and, of these, 79.5% returned home the same day – saving 977 overnight bed stays.

SAM president Dr Nick Scriven said that just a 5% increase in the number of patients who receive their first assessment and subsequent treatment in AEC could save an additional 238 overnight bed stays – which would equate to 14,042 overnight admissions over January and February.

“AEC has obvious benefits for the patient in that they usually remain in their own clothes, remain mobile and get to sleep in their own beds while, for the hospitals, it is a way of alleviating overnight bed pressures,” he said.

“Given how much pressure we are all under, it would seem reasonable to look at how much could be achieved with investment in this area. From our projections, just a 5% increase in the number of emergency patients being seen in AEC could save at least 14,000 overnight beds days across the busiest winter months.”

In September, SAM warned the additional 900 beds the Department of Health and Social Care’s additional £145 million investment this would cover falls 3,100 short of the number required last winter.

Dr Scriven urged the government to look at “how much could be achieved with investment in this area” and address why the implementation of AEC units was “not standard or uniform” across the country.

“With winter rapidly approaching the NHS is on borrowed time. AEC would seem to be an area that is beneficial to both patients and the service but is variably used throughout the country. To evoke maximum benefit, a significant investment and national plan for this area is required.

“In the interim, we believe the government and NHS leaders should realise urgently the potential of AEC to have a transformative effect on bed capacity and develop a broad-based guidance to help advise hospital trusts on utilising AEC as efficiently as possible.”

The Royal College of Emergency Medicine (RCEM) welcomes SAM’s report.

Dr Taj Hassan, President of the RCEM, said: “We fully agree with the Society of Acute Medicine (SAM) that NHS Leaders need to make better use of ambulatory emergency care (AEC) as a way of reducing potential admissions this winter. The SAM's recent audit shows just how effective it might be.

"Patients quite naturally want to be back in their own homes as quickly as possible, and AEC is a good way of enabling this where appropriate. Not only is it good for the patient but also the hospital as it helps reduce unnecessary admissions, increases safety and improves flow.”

However, he said these measures alone would not “prove to be a silver bullet”.

“These measures are ones that can be taken to lessen the impact of winter while systems await real action in the form of a credible ten-year plan and extra, sustainable funding for workforce planning, acute hospital beds and social care.”

A spokesperson for NHS England said: "Increasingly in hospitals, new bedside tests and rapid treatments combined with support in the community mean that hospitals can help get patients safely home on the same day. This works for many sudden illnesses and particularly helps older people avoid unnecessary admission to hospital wards and is something that all hospitals should consider as we head into the winter period.”

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