The acute medical emergencies guideline could look at a range of settings – that provide immediate medical assistance – including ambulance teams, accident and emergency units, out-of-hours GP services and discharge planning.

NICE has published a draft scope and is now seeking views from all healthcare professionals, as well as members of the public, to decide the relevant issues and what key topics the recommendations should focus on.

Demand for acute NHS services is substantial and increasing across the whole system. Last year over 20 million people visited A&E, an increase of almost a third (32%) in the past decade. Emergency admissions to England’s hospitals reached over 5 million. In 2011/2012 there were over 8 million calls to 999 and more than 6 million ambulance journeys made.

The costs of emergency admissions have been increasing at about £83 million per year since 2004, with the cost to the NHS at £11 billion in 2009.

Professor Mark Baker, clinical practice director at NICE, said: “Medical emergencies can happen to anyone at any time. They may be the result of a serious illness, the sudden worsening of chronic disorders like heart failure, or where someone’s condition deteriorates after they’ve been discharged from hospital.

“Acute services are under increasing demand, with capacity close to the limit, staff and facilities are continuously under pressure. In some areas great efforts have been made to deal with the pressures on services and we have seen examples of innovative practice providing excellent care.

“However, there is still unacceptable variation across the country, with some recent reports finding that people are readmitted just days after discharge from emergency care and weekend admissions can be associated with a significantly increased risk of dying. What we have is a system struggling to meet increasing demands and this needs to change.

“As demand on acute services continues to grow, we must ensure that we have a systematic approach to service design and organisation in place to standardise best practice across the country. This NICE guideline will look at all settings where NHS care is provided for acute medical emergencies. It will address issues such as access to services at all times of day or night, appropriate staff skill mix, handover planning after discharge and alternatives to acute care in hospital.

“This one of the most ambitious and important guidelines that NICE has developed. We want to hear from all those who can provide relevant input for our guideline development group to consider as they make their recommendations.”

The draft scope will be open for public consultation until Wednesday 11 November. Although only registered stakeholders (such as professional and government organisations, patient and carer groups and companies) can formally comment on NICE consultations, organisations can register as a stakeholder at any time during the development of a guideline. Individuals are advised to pass comments through the registered stakeholder organisation that most closely represents them.

The publication date of the final guideline is yet to be confirmed.  

Ends

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Additional information

1. There were 21.7 million attendances at emergency departments, minor injury units and urgent care centres in 2012/13. These attendances increased by 32% since 2003/04 almost exclusively in minor emergency department attendances (e.g. urgent care centres, minor injury units and walk-in centres).
2. There were 5.2 million emergency admissions to England’s hospitals in 2012/13. Emergency admissions, which include short-stay and zero length-of-stay admissions (a patient admitted and discharged on the same day), have increased by 40% between 2003/04 and 2010/11.
3. Nearly 5% of all admitted patients in England are re-admitted as emergency cases within 30 days. Nearly half of re-admitted patients return to a hospital within 7 days of their initial discharge. The re-admission rate for people aged 16 74 increased from around 7% in 1998/9 to 9% in 2006/7. The equivalent figures for people aged 75 and over are 10% and 14% respectively.
4. The draft scope is available at /CG/Wave0/734/ScopeConsultation.