Guidance

Context

Context

NICE's service guidance on emergency and acute medical care supports the next steps in the NHS five year forward view. It presents a survey of the best available evidence on a range of questions across the emergency and acute care pathway, which reaffirms key aspects of care articulated in the NHS seven day services clinical standards, including the role of early consultant review after admission to hospital, daily consultant review in hospital, multidisciplinary care, structured handovers and liaison mental health services.

This guideline covers service organisation and delivery in the following topic areas referred to NICE by the Department of Health in 2012:

  • urgent and emergency care

  • out-of-hours care

  • 7-day services

  • consultant review within 12 hours of admission

  • acute medical admissions within the first 48 hours

  • discharge planning to reduce readmissions.

Hospitals have found it increasingly challenging to maintain the flow of patients through from admission to discharge. The guideline committee considered interventions that avoid hospital admission and facilitate earlier discharge, when this can be achieved safely and without an increase in readmissions.

A comprehensive review of the evidence was conducted on sometimes complex interventions within this field. The guideline committee also took account of national initiatives such as the Keogh urgent and emergency care review that began in January 2013.

The guideline contains recommendations for practice and for research. Commissioners of services should take note of both types of recommendation when planning services.

Commissioners are encouraged to read the evidence reviews, particularly the sections headed 'Recommendations and link to evidence', for more details about the interventions, references to other national initiatives and the committee's deliberations. A link to the relevant evidence review is at the end of each recommendation.

The guideline committee did not include detail in the recommendations about how they should be implemented (such as how many staff are needed or the exact content of an intervention) because the most cost-effective solution is likely to vary depending on local systems.

The recommendations for practice are grouped into 3 sections covering services in the community, services in hospital and service planning.