Strategies to identify medical patients suitable for management through same-day emergency care services: A systematic review

Abstract

Same-day emergency care (SDEC) in unplanned and emergency care is an NHS England (NHSE) priority. Optimal use of these services requires rapid identification of suitable patients. NHSE suggests the use of one tool for this purpose. This systematic review compares studies that evaluate the performance of selection tools for SDEC pathways.Nine studies met the inclusion criteria. Three scores were evaluated: the Amb score (seven studies), Glasgow Admission Prediction Score (GAPS) (six studies) and Sydney Triage to Admission Risk Tool (START) (two studies). There was heterogeneity in the populations assessed, exclusion criteria used and definitions used for SDEC suitability, with proportions of patients deemed ‘suitable’ for SDEC ranging from 20 to 80%. Reported score sensitivity and specificity ranged between 18–99% and 10–89%. Score performance could not be compared due to heterogeneity between studies. No studies assessed clinical implementation.The current evidence to support the use of a specific tool for SDEC is limited and requires further evaluation.

Keywords

• Acute medicine
• Admission pathways
• Same day emergency care
• Scoring