“…
Factors independently associated with hospital admission were severe illness (SIRS/point, OR = 1.46, 95% CI = 1.15–1.87, p = 0.002) and markers of frailty: delirium (OR = 11.28, 3.07–41.44, p < 0.0001), increased care needs (OR = 3.08, 1.55–6.12, p = 0.001), transport requirement (OR = 1.92, 1.13–3.27), and poor nutrition (OR = 1.13–3.79, p = 0.02). Even with MDT approach, rates of hospital admission in those with severe illness and frailty were high | 40 | Service review – retrospective medical notes audit Pre and post SDEC (July 2013/July 2014) | Two acute sites, one trust 191 patients pre-SDEC 344 SDEC | SDEC patients had fewer diagnostic tests All SDEC patients discharged opposed to 2/3 discharged the same day pre-SDEC | Improved admission avoidance Reduced diagnostics (more targeted) Increased efficiency |
39 | Report on direct streaming from ED to SDEC, with four pathways | 4-day period in September 2019 | 33 patients, only two admitted, so 93.93% discharged Average waiting time for ED 5 h 44 min, compared to 49 min in SDEC | Factor leading to unnecessary admissions was traditional referral process between ED and medicine |
43 | Audit of referrals to SDEC within an acute medical unit, 1 week period in 2018, prior to new medical unit opening, and re-audit afterwards in 2019 Education provided to medical team in between | Pre-SDEC 118 referrals SDEC 88 referrals | Pre-SDEC: 36% from acute medical team, 28% ED, 24% GPs, 12% inpatient wards for post-discharge review 31% of referrals rejected by consultant (majority from GPs, but 28% from medical on-call team) 30% referred onto other specialties/clinics Post-SDEC rejected referrals 18%, onward referral 19%, increase in post-discharge referrals to 32%, increase in referrals to follow up blood tests to 28% | Large number of inappropriate referrals Medical hot clinics would reduce inappropriate referrals Consultants should follow up own inpatient results, not refer to SDEC |
30 | Review article | | | Patient selection key Early senior decision making 30% of patients can be managed in SDEC Improved patient experience Need clear pathways and processes |
11 | Review article | | | Process driven, rather than condition specific pathways Ambulatory by default recommended Acute generalists, including advanced nurse practitioners, acute medicine, ED, or GP clinicians Rapid access to diagnostics key Risk inherent – identifying safe discharges Outcome & experience metrics are needed |
44 | ... |
…”