Ambulatory emergency care - manage your emergencies as day cases


While access to emergency care has improved considerably in the NHS, further attention is now required to ensure that only those patients who actually require admission to an acute hospital bed are admitted and that their length of stay is commensurate with their acute care needs.

The Directory of Ambulatory Emergency Care for Adults (the Directory) was published in 2007 by the NHS Institute, identifying 49 emergency conditions and clinical scenarios (e.g. cellulitis) that have the potential to be managed on an ambulatory basis. The underlying principle is that admission to a hospital bed should only take place in the context of an acute illness that requires inpatient care. Ambulatory models create a ‘virtual ward’ of patients only using services which truly add value to their treatment.

The NHS Institute and the NHS South East Coast SHA are working until spring 2010 to test the implementation of the Directory in 8 acute hospitals in the South East Coast.

If you are within NHS England and would like a hard copy of the Directory posted to you, please email Sarbjit Purewal. If you are outside NHS England please contact worldwide for details of the cost and how to order this publication.

The purpose of this work is to:

  • To implement changes in clinical practice from the Directory of Ambulatory Emergency Care for Adults
  • To achieve the benefits associated with increased ambulatory emergency care:
    • Improved patient experience and outcomes
    • Transformed emergency care processes
    • Released acute care beds
  • To understand the success factors, risks and barriers to implementation

Participating hospitals to date are:

Eastbourne District General Hospital (DGH), East Sussex Hospitals NHS Trust:

  • Eastbourne DGH is working to implement the Respiratory/Leg ‘bundle’ of the Directory, with an initial focus on developing ambulatory pathways for cellulitis and pulmonary embolism (PE).

Ashford & St. Peter’s NHS Trust:

  •  St. Peter’s is working to implement the Respiratory/Leg ‘bundle’ of the Directory, with an initial focus on developing ambulatory pathways for community-acquired pneumonia and pulmonary embolism (PE)

Medway NHS Foundation Trust :

  • Falls and reducing admissions from nursing and residential homes

Frimley Park Hospital NHS Foundation Trust:

  •  PE, pleural effusions and headache

Surrey and Sussex Healthcare NHS Trust:

  •  Cellulitis, supra-ventricular tachycardia, pneumonia and abscesses

The learning from NHS South East Coast will be used to support NHS-wide roll-out of the Directory.

Regional events: 

The NHS Institute has been working with seven acute trusts in the Souht East Coast to test the implementation of ambulatory emergency care pathways and to use their experiences to develop a 'how-to' guide to ambulatory emergency care for the NHS.


An event in March 2010, co-hosted by NHS South East Coast, allowed participating sites to share their achievements and lessons learned.

Presentation slides from the highly successful day are below.

Regional Ambulatory Care Event 25 March Regional Ambulatory Care Event 25 March (1.17 MB)

Innov on Acute Medical Unit - Part 1 Innovation on Acute Medical Unit - Part 1 (1.68 MB) 

 Innov on Acute Medical Unit - Part 2 Innov on Acute Medical Unit - Part 2 (925.10 KB)

 * Please note that the NHS Institute is an innovation and improvement organisation and is unable to give medical advcie to patients or their carers.



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