Article | The evolution of same day emergency care (SDEC)

It’s been nearly two years since we first introduced Symphony 3.0, with a range of exciting enhancements to support same day emergency care (SDEC). The SDEC model aims to reduce hospital admissions and wait times by treating emergency care patients within the day that would otherwise be admitted. We spoke to Optum Clinical Director and Consultant Emergency Physician, Dr Haidar Samiei for his thoughts on how the SDEC model is evolving, where the challenges remain, and how we might tackle these challenges going forward.

As the SDEC model beds in across the NHS we’re already seeing the positive effects it can have. Trusts are seeing entire cohorts of patients being siphoned out of the emergency department (ED) enabling their needs to be dealt with in a more streamlined, consistent, and efficient manner. This allows the ED and high-volume receiving specialty areas to focus more on their core purpose. Model hospital data shows that 80% of patients seen in SDEC have a 0-day length of stay, whilst patients managed through wards have an average 4.2 day length of stay. As pressures on beds and capacity continue to grow, reducing length of stay and efficiently managing patient care is essential.

We’re seeing teams approach SDEC in different ways as they explore how their local processes fit together for new, improved patient journeys that free up capacity in the ED, whilst also improving access, safety, experience and outcomes. This has given us an opportunity to consider how we can continuously expand Symphony’s functionality, as well as partner to leverage other systems capabilities.

The challenge within the NHS remains demand, capacity and complexity. Whereas in the past we re-routed patients pre-hospital to decrease demand, we are now using SDEC to cohort patients with similar urgent care needs to decrease variability and allow standardised processes, effectively creating capacity for larger volumes.

Through Symphony’s market-leading interoperability capabilities we’re providing ever improving views of information from different sources: GPs, 111, ambulance transfers, and transfer of care from symphony back to primary care. All of these aim to decrease duplication of work, improve safety and get patients to the right place as quickly as possible.

Previously, overwhelmed EDs could use predictable peaks and troughs of activity to reset themselves; using the late night-early morning lull to catch up. The lack of SDEC or specialist streaming services to offload EDs at these times, combined with increased inflow and decreased outflow, means that some departments are now struggling to reset themselves at all, leading to never ending long clinician and bed waits. What can be done?

Explore Haidar's thoughts in a series of articles: