Impact of same day emergency care services on urgent and emergency care delivery outcomes: a systematic review.

Abstract

Introduction: Same day emergency care (SDEC) describes an ambulatory service designed to provide an alternative to ED management, reduce admission rates and improve emergency care system performance. This systematic review aimed to identify and synthesise the evidence base for SDEC and its impact on urgent and emergency healthcare delivery.

Methods: Eight bibliographic databases were searched, including: MEDLINE, EMBASE, PsycInfo, CINAHL, the Science and Social Science Citation Indices in the Web of Science Core Collection, Health Management Information Consortium, the Cochrane Library and Epistemonikos. Study selection, extraction and quality assessment were conducted independently by two reviewers. Given the clinical heterogeneity and weakness of the evidence base to determine intervention effect, a narrative synthesis was performed. Formal assessment of implementation was undertaken using the Quality Improvement Minimum Quality Criteria Set.

Results: We identified 1283 citations, with 21 publications reporting 20 evaluations (18 UK and 2 Australia). SDEC services were heterogeneous in terms of referral sources, patient selection and specialties provided. Studies were mostly single centre and compared SDEC care with alternative services (such as ED) or compared outcomes before and during SDEC implementation. Patients receiving SDEC demonstrated same-day discharge ranging from 38.3% to >92%. 30-day mortality varied between <1% and 6% (four studies). Change in 30-day ED or SDEC reattendance was not examined. A learning curve was indicated in two studies, with inappropriate or 'rejected' referrals reducing from 31% to 18% in one SDEC service. Where reported, triage was led by senior clinical decision-makers, however, the appropriateness of SDEC referrals was also complicated by contextual factors. Comparative evaluation, including inpatient admissions, generally favoured SDEC care, but study designs carried a high risk of bias and confounding.

Conclusions: Limited evidence suggests that implementing SDEC services is feasible and may increase same-day discharge but with variable 30-day mortality (very-low or low confidence) and unexamined change in 30-day ED or SDEC reattendance. Clinical heterogeneity and limited reporting make it difficult to characterise SDEC services. Implementation, although with varied referral criteria, proved feasible given the involvement of senior clinical decision-makers.