NHS Area Case Study | Same Day Emergency Care (SDEC) In South East London

Published: 10th June 2022
South East London CCG have set up links to efficiently route GPs to their Same Day Emergency Care (SDEC) services, allowing for a more specialised approach when it comes to treating patients requiring urgent medical care. We recently caught up with Dr Roshan Navin, GSTT Clinical Lead for Acute Medicine & SDEC to find out his experience of the SDEC service via Consultant Connect.

In 2016, a small, 4-specialty project in Greenwich feeding into Lewisham Hospital was the acorn from which the mighty South East London project grew. As the geographic footprint of the project expanded into the neighbouring boroughs of Bexley, Bromley, Lambeth, Southwark, and Lewisham, so did the ambition of management to use the technology to deliver right care, first time.

Today primary care clinicians can access rapid Advice & Guidance from over 50 NHS specialties across Elective and Urgent Care using telephone or photo messaging.

For example, South East London CCG have set up links to efficiently route GPs to their same day emergency care (SDEC) services, allowing for a more specialised approach when it comes to treating patients requiring urgent medical care. As well as primary care clinicians, in 2021 the service was extended further to provide clinicians working in 111 Integrated Urgent Care (IUC) service with access to the Same Day Emergency Care (SDEC) lines at Guy’s and St Thomas’ NHS Foundation Trust (GSTT), King’s College Hospital (KCH) and Lewisham and Greenwich NHS Trust (LGT) and 999 paramedics from April 2022.

We recently caught up with Dr Roshan Navin, GSTT Clinical Lead for Acute Medicine & SDEC to find out his experience of the SDEC service via Consultant Connect.

What was your initial aim with setting up your SDEC services in SEL?

“We set up SDEC services to streamline care and make it as efficient as possible for patients, clinicians, for the operational system, and the community.

 

SDEC aims to remove any unnecessary delays for patients who require specialist input, further investigation, or urgent treatment for their conditions.  It helps manage acutely unwell patients and creates improved patient flow from the point of referral to their arrival in secondary care, whilst enabling earlier access to senior clinical decision making and maximising the opportunity to complete patient care within the same day, whenever possible.

 

SDEC is about giving patients access to the right care in the right place first time. Rapid assessment, diagnosis and treatment for their acute medical conditions significantly reduces the likelihood of inpatient admission to a hospital ward. It also enables us to allow the patient to return to hospital in a planned manner for additional treatment, or monitoring that would otherwise have required inpatient admission and overnight hospital stay.”

Was this influenced/altered by Covid?

“SDEC was crucial in freeing up the inpatient bed base capacity, not only for Covid patients, but also non-Covid patients. A lot of the non-Covid patients were able to be treated through SDEC without impacting the use of beds for Covid during the peak pandemic.”

Why did you implement access to SDEC via Consultant Connect?

“Moving SDEC access to Consultant Connect enabled us to offer a standardised process for all, a single referral route, a single point of access, and audit and monitoring of referral activity demand and outcomes. It also provided an understanding and oversight of options offered by other specialties and services, which helps offer more joined up care plan for patients and provide the most appropriate options available to them.”

What was the SDEC pathway for a GP before being able to access it via Consultant Connect?

“GPs would have to go through different processes for different hospitals. For the admission of a medical patient, the patient would often just be sent to A&E with a GP letter. The patient could also be referred to the medical registrar on call through the hospital switchboard. The GP would have to phone and wait for the hospital switchboard, be put through to a bleep holder, go through the hospital bleep system, and wait for an answer which had a variable reliability. This would often mean that the GP would have to wait a considerable amount of time to get through, which would have obviously been frustrating and inefficient.”

 

Has the SDEC Consultant Connect service improved operations and the patient experience?

“It has been excellent for the patient experience. It has reduced unnecessary delays due to the rapid access to expert senior specialists. The specialist advice also results in patients being treated out of hospital where appropriate.”

 

Why is it useful to receive calls from other clinicians either in primary care or from paramedics, or from across different health disciplines? 

“Clinician-to-clinician discussion is vital, it provides accurate patient information, minimises the need for patients to repeat the same information and is better for patient safety. The conversation offers a direct referral pathway to specialists and can bypass the ED. The referrer can discuss patient attendance at a time suitable for the patient, and dependent on their clinical urgency, we can either expedite a patient being seen, or we can offer a more appropriate time for the patient to be seen if that is more suitable for them.”

 

Can you provide an example of a positive experience via the Consultant Connect phone service to the SDEC?

“A recent example is that of young taxi driver who was seen by his GP with a ten-day history of intermittent chest pains. The GP was concerned and not entirely sure what to do. The GP used Consultant Connect to call the SDEC line and was advised that the patient should be referred that same day to the SDEC unit. The patient was seen rapidly, given immediate treatment on suspicion for unstable angina and was referred to the cardiology team before any diagnostic tests had even been reported.

 

With the specialist input from SDEC, and then the direct referral to cardiology, the patient underwent invasive coronary angiogram the same day which demonstrated right coronary artery disease and that he needed two stents put in.

 

By referral through Consultant Connect the patient received the correct advice and management plan within four hours. Had the patient waited 1-2 days as an inpatient for this that would have been highly inefficient for the patient, a poor use of clinician time, and poor use of the inpatient bed base. Waiting two weeks as an outpatient for this intervention could have been catastrophic for the patient’s care, without the early specialist input through SDEC.”

If you would like to discuss how we can help your NHS area, please contact us: hello@consultantconnect.org.uk or 01865 261 467.

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