About the project

The problem

• Throughout a year, on average, 95% of hospital beds are full (source). Hospitals struggle to work effectively with so little breathing room.

• At the same time, emergency departments are in high demand, unable to send patients away and discouraged from admitting any more patients unless absolutely necessary.

• But just over half of patients admitted from the emergency department stay less than two days (source), which makes some people believe that these patients don't need to be admitted.

• Extra resources to help emergency departments might avoid these admissions and the demand for hospital beds.

A solution?

• Same Day Emergency Care (SDEC) services were encouraged in the NHS Long-Term Plan to deal with both the high demand in emergency departments and hospitals' lack of available beds.

• SDEC services do this by offering care that is more than emergency departments can provide but less than what is provided to admitted patients; a middle ground.

• Not much guidance was given in the NHS Long-Term Plan so emergency departments have set up and delivered their SDEC services in many ways.

• We don't know which kinds of SDEC services work well and which do not.

Our proposal

Our project wants to understand the different ways of providing SDEC services, and to evaluate how well they reduce both crowding in emergency departments and admissions to hospital.

The goal is to guide hospitals toward the best ways of providing healthcare. This should lead to better experiences and better outcomes for all of us who use emergency healthcare services.

Our plan

We have three work-packages involving seven studies. Scroll down to find out a little bit more about our timeline and each work-package.

Work-package #1 (WP 1)

Our first work-package sets the foundation for the rest of our work. It will provide a clear definition of what SDEC services are in practice, and a taxonomy of the ways that SDEC services are setup and delivered in NHS England.

• Work-package 1a (WP1a) is a review of the published research that will provide definitions of, descriptions of, and reports of the actual use of SDEC services and the patients that use them.

• Work-package 1b (WP1b) is a national survey of type-1 emergency departments in NHS England that will inform a taxonomy of the ways that SDEC services are setup and delivered.

Work-package #2 (WP 2)

Our second work-package involves the first set of analyses of healthcare data. It will provide the first national evaluation of SDEC services in NHS England.

• Work-package 2a (WP2a) is a study describing trends in health outcomes, both over time and between hospitals.

• Work-package 2b (WP2b) is cost-consequential study that will describe the policy-level effect of SDEC services on policy outcomes and NHS costs.

Together, both studies will inform our first major report on the impact of SDEC services.

Work-package #3 (WP 3)

Our third work-package involves both database and face-to-face studies of SDEC services. It will provide a closer look at a handful of hospitals who provide SDEC services. These "case studies" are an opportunity to study the varied impacts that the SDEC initiative has had in different hospitals.

• Work-package 3a (WP3a) is a case-study time-series analysis of how SDEC services have affected hospital admissions and the performance of emergency departments.

• Work-package 3b (WP3b) is a case-study time-series analysis of how SDEC services have affected economic and financial outcomes.

• Work-package 3c (WP3c) is a our face-to-face study of SDEC services to understand the factors that affect how SDEC services are set up and delivered. We will observe staff and patients during a typical day in SDEC services, and invite staff and patients for in-depth interviews.

Together, these three studies will inform our second major report on the impact of SDEC service, diving deeper into the experiences of example hospitals.