Medical Same Day Emergency Care (SDEC)
🏥 Overview
Medical SDEC provides same-day assessment, diagnosis and treatment for patients who can be safely managed without overnight admission.
❌ General Exclusion Criteria
Patients with ANY of the following should NOT be referred to Medical SDEC:
| Criterion | Details |
|---|---|
| GCS | 14 or Less |
| Care Needs | Patient requires 1-1 care |
| Confusion | Acute confusion/delirium |
| Dementia | With complex needs |
| Infection Risk | Diarrhoea, COVID symptoms, C. Diff etc |
| NEWS Score | 5 or more |
| Alternative Pathway | Patient suitable for TIA Clinic, Falls Clinic, CAU, DVT Clinic, RACP Clinic etc |
❌ Condition-Specific Exclusion Criteria
Chest Pain
- Ongoing pain with ECG changes
- High initial troponin
- Haemodynamic instability (SBP < 100, Pulse > 110 or <60)
Headache
- History of seizure
- Ongoing focal neurological deficit
- Suspected meningo-encephalitis
Pulmonary Embolism
- Significant hypoxia
- SBP < 100
- Pulse > 110
- Massive PE on scan
DVT
- Extensive clot with arterial compromise (clinical or on scan)
- If suitable for VTE Clinic instead
Upper GI Bleed
- High Blatchford score (>1)
- SBP < 100, Pulse > 100
- Ongoing bleed, hematemesis
- History of varices or liver disease
Anaemia
- Ongoing overt bleeding
- Anaemia with cardiac failure
- Suspected haematological malignancy or haemolysis
Pneumothorax
- Large (>2cm) size on CXR
- Underlying lung disease (COPD, fibrosis)
- With effusion (hydrothorax or haemothorax)
Syncope/Collapse
- History of seizure
- Ongoing focal neurological deficit
- SBP < 100, Pulse > 110 or < 60
- Ongoing chest pain with ischaemic changes on ECG
Atrial Fibrillation
- Pulse > 120
- SBP < 110
- Pulmonary oedema
- AF due to acute illness
- Ischaemic changes on ECG or ongoing chest pain
⬇️ When Patients Are Too Well for Medical SDEC
Alternative Pathways
Some commonly referred conditions are better managed via alternative routes:
Bloods Reviews
| Scenario | Action |
|---|---|
| Repeat bloods/symptom review | GP via discharge letter or relevant OP team |
| Patient needs closer monitoring | Refer to Virtual Ward |
| Known, historic conditions | GP via discharge letter |
| Mg, PO₄, or Na testing only | Community Bloods Team (referrer reviews results) |
IV Treatments
| Treatment | Pathway |
|---|---|
| Planned blood transfusion | PIU |
| Unplanned blood transfusion (previous success, under consultant) | Home Blood Transfusion Team |
| IV antibiotics (previous success, under GP/consultant) | Hospital at Home Team |
| Iron transfusions (planned) | PIU |
Scans/Diagnostic Tests
| Test | Action |
|---|---|
| VTE work ups | VTE Outpatient Clinic (unless pregnant, immobile, querying PE, upper limb, or needs further investigation - then SDEC) |
Test/Scan Results Reviews
- Results via letter from referring consultant
- Telephone call if further action required
DENOSUMAB Injections
- Refer to Frailty Team
📞 Contact
Unsure About Suitability?
Discuss with SDEC staff on 0300 707 2361