Summary of results
Overall compliance across all answered criteria was 83.2%. SDEC suitability was considered in 80.6% of episodes, NEWS2 or equivalent acuity assessment was documented in 93%, and a senior decision-maker was involved in 77.4%. Same-day discharge was achieved in 38.7% of episodes and reason for admission was documented in 73.7% of admitted episodes. 28 criteria fell below the 90% target and 2 met it. The most frequently recorded reason SDEC was not used was "SDEC closed / outside opening hours".
Interpretation
Strongest performance was seen in C21 (90.9%), C5 (90%), C19 (89.8%). The largest gaps were C23 (74.5%), C14 (76.8%), C28 (77.4%). Compliance was lowest in Frailty Assessment Area at 81% (n=16). 3 episodes were recorded as potentially suitable but not referred, which is the clearest admission-avoidance opportunity. Where sample size is small, findings should be treated as indicative and confirmed with further data collection.
Areas of good practice
Highest performing criteria.
- c21Specialty advice was completed same day where required for safe SDEC management.90.9%
- c5NEWS2 or equivalent acuity assessment was documented.90%
- c19Required treatment was identified and delivered same day where relevant.89.8%
- c13Referral route used was appropriate to local policy.89.1%
- c22Discharge plan was documented where same-day discharge was intended or achieved.88.2%
Key gaps identified
Lowest performing criteria against the local target.
- c23Safety-netting advice was documented.74.5%
- c14SDEC referral outcome was documented.76.8%
- c28Alternative pathway was documented where SDEC was not used.77.4%
- c12Reason for not referring to SDEC was documented where the patient appeared potentially suitable but was not referred.77.6%
- c20Pharmacy, medicines or prescribing support was completed where required.77.8%
Reasons SDEC was not used
- SDEC closed / outside opening hours6
- Safeguarding concern4
- No reason documented3
- Cognitive / capacity concern3
- Diagnostic requirement not available same day3
- High NEWS2 / clinical instability2
- Mobility / functional safety concern2
- Social support / home circumstances concern2
- Requires resuscitation or emergency pathway2
- Requires inpatient monitoring2
- Patient declined SDEC / same-day pathway1
- Documentation unclear1
- Referral not recognised1
- Transport home unavailable1
- Treatment requirement not available same day1
- Suspected sepsis requiring admission1
- Specialty review not available same day1
- Requires urgent critical care / high-dependency review1
- No senior decision-maker available1
Safety and data quality
Safety concerns recorded: 5
Potentially suitable but not referred: 3
Suitability not considered: 12 episodes
Criterion responses recorded as unable to determine: 42
Lessons learnt
Reliable SDEC use depends on early suitability screening at the point of streaming, clear and visible local inclusion and exclusion criteria, senior decision-maker availability and same-day access to diagnostics. Where suitability is never considered, the episode is lost to admission before any clinical barrier applies — documentation prompts at streaming address this more effectively than clinician education alone.
Limitations
Single-service audit of 62 pseudonymised episodes over the selected audit period. Retrospective record review depends on documentation quality, so "Unable to determine" responses (42 across all criteria) may understate actual practice. Results may not represent weekend, overnight or out-of-hours activity where SDEC access differs.
Recommendations
1) Add an SDEC suitability prompt to ED streaming and AMU clerking so consideration is always recorded. 2) Make local inclusion and exclusion criteria visible at the point of decision. 3) Agree same-day diagnostic slots reserved for SDEC. 4) Require a documented reason whenever a potentially suitable patient is not referred or is declined. 5) Feed decline and non-referral reasons back to ED, AMU, ambulance and community referrers. 6) Re-audit after intervention using the same criteria and tool version.