Inclusion criteria
Episodes that should be included in the audit sample.
- Adults aged 16 years or older unless locally adapted.
- Patients presenting to ED, AMU, SDEC, ambulatory care or urgent assessment pathways.
- Patients referred or considered for SDEC.
- Patients who were admitted but may have been suitable for SDEC.
- Patients streamed from ED or UTC to SDEC.
- Patients referred directly by GP, NHS 111, ambulance service, community services or other approved routes.
- Patients with conditions included in local SDEC pathways.
- Patients managed in selected wards, units, departments or pathways.
- Electronic, paper or hybrid records depending on local setup.
Exclusion criteria
Episodes that should not be included.
- Patients under 16 years old unless locally adapted.
- Maternity-specific SDEC pathways unless locally adapted.
- Paediatric SDEC pathways unless locally adapted.
- Patients requiring immediate resuscitation or emergency treatment outside SDEC scope.
- Patients requiring critical care, high-dependency care or continuous inpatient monitoring at the point of assessment.
- Patients requiring admission for clearly documented clinical reasons.
- Patients with safeguarding, capacity, social or functional complexity that makes same-day discharge unsafe unless locally supported.
- Patients outside local SDEC opening hours where no alternative SDEC access pathway exists.
- Duplicate records or duplicate SDEC suitability episodes.
- Records outside the selected audit period.
- Records unavailable for review.
- Cases where local governance approval is required but has not been obtained.
- Direct patient identifiers entered into the tool.
Audit standards
Standards this audit is measured against.
- At least 90% of relevant urgent or emergency care episodes should document whether SDEC suitability was considered.
- At least 90% should document assessment against local SDEC inclusion and exclusion criteria.
- At least 90% should document NEWS2 or equivalent acuity assessment.
- At least 90% of potentially suitable patients should be referred to SDEC or have a clear reason documented for non-referral.
- At least 90% of SDEC referrals should have referral outcome documented.
- At least 90% should have diagnostics, treatment and specialty advice completed same day where required for safe SDEC management.
- At least 90% of SDEC discharges should have discharge plan, safety-netting and follow-up documented where required.
- At least 90% of admissions after SDEC consideration or assessment should have reason for admission documented.
- At least 90% should have documentation clear enough for another clinician or coordinator to understand suitability, decision, pathway and next actions.
- At least 90% should have SDEC-related safety concerns escalated or actioned where identified.
Audit criteria
Each criterion is answered Yes, No, Not applicable or Unable to determine. Compliance uses Yes and No responses only.
30 criteria
| Ref | Criterion | Target |
|---|---|---|
| c1 | SDEC suitability was considered for the patient where clinically relevant. | 90% |
| c2 | Local SDEC inclusion criteria were assessed and documented. | 90% |
| c3 | Local SDEC exclusion criteria were assessed and documented. | 90% |
| c4 | Presenting problem or pathway group was documented clearly. | 90% |
| c5 | NEWS2 or equivalent acuity assessment was documented. | 90% |
| c6 | Clinical stability and immediate safety were assessed. | 90% |
| c7 | Senior clinical decision-maker was involved where required by local policy. | 90% |
| c8 | Frailty assessment, Clinical Frailty Scale or equivalent was documented where relevant. | 90% |
| c9 | 4AT, cognition or delirium screening was documented where relevant. | 90% |
| c10 | Safeguarding, capacity, functional or social risk was considered where relevant. | 90% |
| c11 | SDEC referral was made where the patient appeared suitable. | 90% |
| c12 | Reason for not referring to SDEC was documented where the patient appeared potentially suitable but was not referred. | 90% |
| c13 | Referral route used was appropriate to local policy. | 90% |
| c14 | SDEC referral outcome was documented. | 90% |
| c15 | Reason for SDEC referral decline was documented where applicable. | 90% |
| c16 | Transfer from ED / UTC to SDEC occurred within local expected timeframe where applicable. | 90% |
| c17 | Required diagnostics were identified and available within the same-day pathway where relevant. | 90% |
| c18 | Diagnostics were completed same day where required for safe SDEC management. | 90% |
| c19 | Required treatment was identified and delivered same day where relevant. | 90% |
| c20 | Pharmacy, medicines or prescribing support was completed where required. | 90% |
| c21 | Specialty advice was completed same day where required for safe SDEC management. | 90% |
| c22 | Discharge plan was documented where same-day discharge was intended or achieved. | 90% |
| c23 | Safety-netting advice was documented. | 90% |
| c24 | Follow-up plan was documented where required. | 90% |
| c25 | Patient information was provided where relevant. | 90% |
| c26 | Same-day discharge was achieved where clinically appropriate. | 90% |
| c27 | Reason for admission after SDEC assessment was documented where admission occurred. | 90% |
| c28 | Alternative pathway was documented where SDEC was not used. | 90% |
| c29 | Documentation was clear enough for another clinician or coordinator to understand suitability, decision, pathway and next actions. | 90% |
| c30 | Any SDEC suitability, streaming, discharge or patient safety concern was escalated or actioned where identified. | 90% |
Clinical safety note
This tool supports local audit, quality improvement and operational governance review. It does not make SDEC referral or discharge decisions and does not replace clinical judgement, local SDEC pathway criteria, ED streaming policy, ambulance direct referral policy, senior clinical review, NEWS2 escalation, frailty assessment, safeguarding procedures, Mental Capacity Act requirements, discharge policy, diagnostic protocols, specialty advice or emergency escalation pathways. Any clinical deterioration, high NEWS2, haemodynamic instability, sepsis concern, safeguarding concern, capacity concern, unsafe discharge concern, missed diagnosis concern or patient safety risk must be escalated according to local policy. Do not enter patient names, NHS numbers, hospital numbers, full dates of birth, addresses or other direct identifiers.