Acute care service performance during winter: report from the winter SAMBA 2020 national audit of acute care

Abstract

The Winter Society for Acute Medicine Benchmarking Audit (SAMBA) provides the first comparison of performance within acute medicine against clinical quality indicators during winter, a time of increased pressure and demand on acute services. 105 hospitals participated in Winter SAMBA, collecting data over 24-hours on 30th January 2020. 5626 patients were included. Participating units saw a median of 48 patients (range 13-131). Comparison between Winter SAMBA and SAMBA19 found less patients had an early warning score within 30 minutes during winter (74.3% vs 78.9%) and less were seen by a clinical decision maker within four hours (84.9% vs 87.9%). Unplanned admissions represented a higher proportion of workload (92.5% vs 90.1%). Patients were more likely to have a NEWS2 score of 3 or higher (30.1% vs 25.7%). Performance is poorer in winter, and patients are more unwell, needing prompt treatment. Services should ensure high quality care can be maintained through times of increased pressure, including winter.

Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit

“…Although this response rate allows identification of variation in the organisational approaches taken to winter pressures in acute medicine services, there may be differences between participating and non-participating hospitals. While the size of hospitals participating in SAMBA is comparable to the acute hospital services nationally [ 25 ], covering urban and rural locations across the UK [ 14 ], there may have been specific differences in the units that did not participate.…”

“…Questions are developed through a national multi-professional forum, including physicians, nurses and pharmacists, and are informed by national guidance, health care policy and standards set by professional bodies. During Winter SAMBA [ 14 ], additional questions were asked regarding changes made to service delivery during the winter period, based on reports and guidance from the Care Quality Commission [ 12 ], NHS Improvement [ 2 ], NHS England [ 15 ] and Health Education England [ 16 ]. SAMBA is registered with the Healthcare Quality Improvement Partnership (HQIP https:// www.hqip.org.uk ).…”

Performance of scoring systems in selecting short stay medical admissions suitable for assessment in same day emergency care: an analysis of diagnostic accuracy in a UK hospital setting

“…13 Scoring system performance outside these hours may differ, due to differences in access to services and in the patient cohort admitted outside daytime hours. 14 …”

Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population

“…This is a design feature of an acute care pathway that consolidates the tools required to risk stratify and treat acute illness in the hospital setting. The need for some hospitals to emergently re‐allocate the space dedicated to SDEC delivery in order to provide additional in‐patient bed capacity highlights a potential drawback of this approach [15]. Reducing the capability to undertake SDEC may be maladaptive in the medium term, but a hospital at maximum capacity requires an immediate solution.…”