Emergency Care Attendance

An Emergency Care Attendance is a CARE CONTACT.

An Emergency Care Attendance is an individual visit by one PATIENT to an Emergency Care Department to receive treatment.

An Emergency Care Attendance may occur as an unscheduled presentation by the PATIENT themselves, but also as a result of a REFERRAL REQUEST from a GENERAL MEDICAL PRACTITIONER, a direct transfer from an Emergency Ambulance, or via a REFERRAL REQUEST from the NHS 111 Service.

An Emergency Care Attendance may be conducted face to face, or virtually by a CARE PROFESSIONAL from an Emergency Care Department who is qualified to deliver virtual care. In Emergency Care Data Set Version 4, the CONSULTATION MECHANISM (URGENT AND EMERGENCY CARE) is used to differentiate face to face attendances from those conducted virtually.

An Emergency Care Attendance may be either a first or follow up attendance. A follow-up attendance is any subsequent Emergency Care Attendance for the same condition, and this may be planned or unplanned, as defined by the URGENT AND EMERGENCY CARE ATTENDANCE CATEGORY (ECDS V4) / EMERGENCY CARE ATTENDANCE CATEGORY (CDS 6-2-3). All planned follow-up Emergency Care Attendances should follow a clinical decision to discharge the PATIENT to their normal place of residence, but with an ongoing duty of care to follow up. For  Emergency Care Data Set Version 4, where a follow up Emergency Care Attendance is planned, this triggers the start of an Urgent and Emergency Care Extended Care Episode. The Urgent and Emergency Care Extended Care Episode starts at the Urgent and Emergency Care Activity End Timestamp of the Emergency Care Attendance within which the clinical decision that there should be an ongoing duty of care to follow up was taken.

If a PATIENT with an open Urgent and Emergency Care Extended Care Episode attends the Emergency Care Department outside of a scheduled attendance in the Urgent and Emergency Care Extended Care Episode (for example their condition deteriorates and they attend the Emergency Care Department), the unscheduled Emergency Care Attendance should also be recorded as being part of the open Urgent and Emergency Care Extended Care Episode.

The URGENT AND EMERGENCY CARE ACTIVITY IDENTIFIER which identifies the open Urgent and Emergency Care Extended Care Episode must be linked in the ELECTRONIC HEALTH RECORD system, and submitted in the Emergency Care Data Set Version 4 record relating to the Emergency Care Attendance, for all planned and unplanned Emergency Care Attendances  within the Urgent and Emergency Care Extended Care Episode.

During an Emergency Care Attendance the PATIENT may temporarily leave the Emergency Care Department, for example for a Clinical Investigation, whilst still under the clinical responsibility of the Emergency Care Department. Such temporary absences from the Emergency Care Department do not interrupt the Emergency Care Attendance  for that PATIENT.

During a Emergency Care Attendance, when the clinical decision is made that the PATIENT no longer requires ongoing care by the Emergency Care Department, this is recorded as the Urgent and Emergency Care Clinically Ready To Proceed Timestamp.

For a face to face Emergency Care Attendance (where the CONSULTATION MECHANISM (URGENT AND EMERGENCY CARE) is National Code 'Face to face'), the Urgent and Emergency Care Activity End Timestamp (ECDS V4) / Emergency Care Departure Date and Emergency Care Departure Time (CDS v6-2-3) is the time that the PATIENT leaves the Emergency Care Department premises and their clinical care is no longer the responsibility of the Emergency Care Department.

For an Emergency Care Attendance undertaken virtually (where the CONSULTATION MECHANISM (URGENT AND EMERGENCY CARE) is National Codes 'Telephone', 'Video Consultation' or 'Chat Room (Synchronous)'), the Urgent and Emergency Care Activity End Timestamp (ECDS V4) / Emergency Care Departure Date and Emergency Care Departure Time (CDS v6-2-3) is the time that all CARE ACTIVITIES undertaken by the responsible CARE PROFESSIONAL relating to the Emergency Care Attendance are completed.

An Emergency Care Attendance (face to face or virtual) outcome may include:

• The clinical care of the PATIENT is transferred to a different Health Care Provider and the PATIENT leaves the Emergency Care Department premises. This may be before the PATIENT has been formally assessed by a treating CARE PROFESSIONAL (termed 'Streaming'), or after formal initial assessment (as recorded in the Urgent and Emergency Care Initial Assessment Timestamp), when it is a transfer of care based on that clinical assessment by the responsible CARE PROFESSIONAL in the Emergency Care Department

• The PATIENT leaves the Emergency Care Department following formal discharge, with no further clinical care planned as part of an Urgent and Emergency Care Extended Care Episode  

• A decision to admit to a Hospital Provider Spell is taken by the responsible CARE PROFESSIONAL

• The PATIENT leaves the Emergency Care Department for a Same Day Emergency Care Attendance at the same Health Care Provider

• The PATIENT is assessed during the Emergency Care Attendance as requiring ongoing clinical care from the same Urgent and Emergency Care Service, which is to be delivered under a Urgent and Emergency Care Extended Care Episode.

If during the Emergency Care Attendance the PATIENT leaves the Emergency Care Department premises (if being seen face to face), or does not continue engagement with the assigned  CARE PROFESSIONAL during virtual care, then the Emergency Care Attendance is completed. The Urgent and Emergency Care Activity End Timestamp (ECDS V4) / Emergency Care Departure Date and Emergency Care Departure Time (CDS v6-2-3) should record the time at which the CARE PROFESSIONAL responsible for the Emergency Care Attendance made the clinical decision to provide no further care. The URGENT AND EMERGENCY CARE DISCHARGE STATUS (SNOMED CT) should indicate that the PATIENT has left the Emergency Care Department/declined further virtual care, and that clinical care responsibility transfers back to their own usual CARE PROFESSIONAL (for example their GENERAL MEDICAL PRACTITIONER).

For further guidance for Emergency Departments on Initial Assessment and Patient Flow, see the  NHS England  website at: Guidance for emergency departments: initial assessment. https://www.england.nhs.uk/guidance-for-emergency-departments-initial-assessment/