What is same day emergency care ?
Same Day Emergency Care, previously known as Ambulatory Care is not new but does continue to evolve as a concept. The underpinning principle is that coordinated access to assessment, diagnostics and treatment can enable some patients to avoid an overnight hospital stay (admission). Over time, many clinical conditions have shifted from traditional inpatient care to outpatient and same day – DVT and PE are clear examples.
UKAOS members are working with colleagues in acute medicine and emergency care teams to develop guidance and pathways that will support the implementation of ambulatory care pathways for oncology patients. We are also sharing examples of new and innovative AO services.
Please have a look at the links below to find an introduction to SDEC services, some guiding principles and practice examples.
If you would like to add to this information and /or share your SDEC examples, do please contact us.
We will be adding to this area as services develop ,so please revisit regularly for updates.
Urgent and Emergency Care (UEC) is a fundamental aspect of the Cancer patient journey with a high frequency of Emergency Department (ED) attendance and conversion to unplanned admission. For many Cancer patients, the admission pathway may be distinct from the primary treating oncology team and often into a different organisation.
Up to 50% of Cancer patients currently have a short hospital admission (≤ 3 days) often complicated due to a lack of locally available information or agreed clinical pathways and leading to an approach of ‘admit to assess’ rather than ‘assess to admit’. This short-term hospital admission can be viewed as a missed opportunity for some patients to undergo a more coordinated same day assessment and discharge via evolving Same Day Emergency Care (SDEC) services.
UKAOS working in partnership with the Society of Acute Medicine (SAM), UK Oncology Nursing Society (UKONS) and NHS Elect are developing an initial 5 Cancer Ambulatory Pathways to support alternatives to ED and admission for cancer patients who fulfil the criteria and where locally agreed pathways have been implemented.
As a first publication, UKAOS and partners have now developed an evidence-based summary guideline to support organisations and clinicians in offering a standardised ambulatory pathway for cancer patients who are diagnosed with an unexpected Pulmonary Embolus.
The guidance recognises that Cancer patients may present via a number of routes and the supports the key principles for ambulatory management across a range of clinical pathways that might include Medical Same Day Emergency Care (SDEC), Cancer Assessment Units, Outpatient services, Community and Primary Care.
Clinicians are encouraged to work with key partners in implementing local solutions that reflect service configuration and varying links between Oncology and the UEC System.
The expert working group aims to further publish ambulatory guidance by March 31st 2026 including:
- Metastatic Spinal Cord Compression
- Low risk Febrile Neutropenia
- Suspected brain cancer
- Malignant Hypercalcaemia
1.0 Introduction
Cancer patients are at an elevated risk of developing unsuspected pulmonary embolism (UPE), a condition increasingly identified due to the widespread use of multi-slice whole-body computed tomography for cancer diagnosis, staging, treatment response assessment, and surveillance (7-9). UPE is a pulmonary embolism diagnosed incidentally on imaging performed for purposes other than clinical suspicion of PE. The prevalence of UPE in the cancer population is reported to be as high as 5%, with over half of PE diagnoses in oncology centres now classified as unsuspected (10, 11). Evidence indicates that UPE shares similar risk factors, embolic burden, and clinical outcomes with clinically suspected PE, including comparable recurrence risks, major bleeding complications, and survival rates (12-15). Consequently, international guidelines recommend managing UPE with the same long-term anticoagulation therapy as clinically suspected PE (2, 16).
Given the increasing prevalence of UPE in oncology patients, particularly in outpatient settings, risk stratification is essential to optimise care. Validated clinical prediction rules, such as the Hull Score Clinical Prediction Rule (CPR), provide a standardised approach to stratify patients for safe outpatient management while minimising unnecessary hospital admissions (17-20). The Hull score is the only score developed specifically for the ambulatory incidental/unsuspected PE oncology population, making it directly relevant. It does not aim to replace a comprehensive clinical assessment. We emphasise that clinical judgement remains vital, and the scores should be used as an adjunct tool.
Same Day Emergency Care (SDEC) is a broad term that recognises the opportunity to convert potential hospital admissions into a same-day framework delivered through clinical assessment, diagnostics, and therapeutics. The principles of Same Day Emergency Care are outlined in the national service specification, with an aim to provide 7-day services through multiple pathways, including ED, Acute Medicine, Surgery, and Oncology. In many organisations, same-day response may also be delivered via alternative facilities, such as Cancer Treatment Assessment Units, hot clinics, and a wide range of other services that offer a same-day response. The term SDEC reflects this variety of service provision and is not intended to describe a single solution, e.g. medical SDEC.
2.0 Clinical Workup for SDEC Management of UPE
UPE can be effectively managed in an ambulatory care setting, depending