Clinical outcomes of adults accessing acute medical same-day emergency care in the NHS: a retrospective cohort study across two hospitals

Objectives

Same-day emergency care (SDEC) has been rolled out as a model of care in England with a limited evidence base. This study examined conversion to inpatient admission, 30-day reattendance and 30-day mortality, among adults managed through SDEC compared with those admitted for ≤48 hours, as a proxy for low acuity, over a 4-year period, to assess safety and effectiveness in a real-world operational setting across two acute hospital sites.

Design

Retrospective cohort study.

Setting

Two acute hospital sites within one National Health Service (NHS) trust in England, UK.

Participants

Adults aged ≥18 years attending acute medical services between April 2021 and March 2025, managed via SDEC or admitted for ≤48 hours (n=43 970).

Outcome measures

Conversion to inpatient admission, 30-day reattendance and 30-day mortality.

Results

The crude conversion rate from SDEC to inpatient admission was 5.8%. In the multivariable model, increasing age (OR 1.02, 95% CI 1.01 to 1.02), male sex (OR 1.42, 95% CI 1.29 to 1.57) and attendance at the Boston site (OR 1.71, 95% CI 1.55 to 1.90) were associated with higher odds of admission.

30-day prefix-concordant reattendance occurred in around 10% of patients in both pathways. After adjustment, SDEC patients had substantially lower odds of reattendance than those admitted for ≤48 hours (OR 0.26, 95% CI 0.19 to 0.36). The effect of SDEC varied by age (interaction OR 1.02, 95% CI 1.01 to 1.02) and site, with a weaker protective effect at Lincoln compared with Boston (interaction OR 2.12, 95% CI 1.74 to 2.60). Age was associated with a reduction in reattendance (OR 0.99 per year increase, 95% CI 0.98 to 0.99).

30-day mortality was lower in SDEC than in short-stay admission (0.6% vs 8.2%), with pathway remaining a strong predictor after adjustment (OR 0.05, 95% CI 0.04 to 0.07). Younger age was protective, while male sex was associated with higher mortality. Pathway by sex interaction indicated a less pronounced protective effect of SDEC in men.

Conclusions

SDEC was associated with very low conversion to inpatient admission and substantially better short-term outcomes than short-stay admission, including markedly reduced diagnosis-concordant reattendance and lower 30-day mortality. These findings indicate that SDEC is a safe and effective model for managing selected acute medical patients. The consistently favourable outcomes among SDEC attenders suggest that patient selection and operational factors within the emergency pathway may be directing lower-risk patients towards SDEC, highlighting the need to review how SDEC capacity is targeted to ensure alignment with its intended clinical role.