How to read the badges on every page
| NHSE | National NHS England spec/guidance — applies everywhere |
| NICE | NICE guideline — national clinical standard |
| GM | Sourced directly from a GM trust or NHS GM ICP page |
| Other trust | Structural template from a non-GM trust — NOT confirmed GM practice |
| Gap | No public source found — needs Greenroom / direct confirmation |
National Rules (apply everywhere)
Who SDEC must NOT take (any specialty, any site)
- Clinically unstable patients
- Patients who clearly require inpatient admission at referral
- Patients requiring resuscitation or immediate/time-critical intervention
- Patients awaiting discharge or transfer (SDEC is not a discharge lounge / overflow ward)
- Type 2/3 ED attenders who belong in ED/UTC under the 4-hour standard
Generic exclusion criteria — on-scene ambulance referral specifically
- Time-critical condition requiring immediate treatment on arrival
- Patient requires resus
- Age under 16 (adult SDEC)
- Trauma patient requiring immediate transfer per major trauma plan of care
Considered on assessment: NEWS2 score, age, medical/surgical working diagnosis, Clinical Frailty Scale. Some providers use NEWS2 <5 as a working threshold for medical patients — higher scores need senior clinician discussion, not automatic rejection.
Referral standard: DDI call to SDEC clinician before conveyance; if not accepted following clinical discussion, convey to most appropriate alternative (usually ED). Handover to receiving service within 15 minutes of arrival.
NHS England high-volume pathway list (11 items, ambulance referral document)
Minimum list trusts should accept direct ambulance referral for — but each SDEC still applies its own local threshold/exclusions within these:
- Falls without injury
- Cellulitis
- Community acquired pneumonia
- Pulmonary embolism
- DVT
- Chest pain
- Shortness of breath (COPD/heart failure/asthma)
- Early pregnancy bleeding
- Palpitations
- Atrial fibrillation
- Acute headache
The broader service spec (medical + surgical) adds: anaemia, gastritis, suspected ureteric stone, appendicitis, suspected biliary colic/cholecystitis, suspected diverticulitis, neutropenic sepsis, abscess, Hickman line issues.
GM Opening Times & Contacts
NHS GM ICP · last updated 23/10/2025, cross-checked vs trust pages| Site | Borough | Hours | Contact |
|---|---|---|---|
| Manchester Royal Infirmary (ACU) | Manchester | 8am–9pm, 7 days (arrive by 6pm) | 0161 701 0353 |
| Wythenshawe Hospital | Manchester | 8am–8pm, 7 days | MFT switchboard |
| Royal Bolton Hospital | Bolton | 7 days, ~8am–8/10pm (page vague — confirm) | 01204 390 390 |
| Fairfield General (SDEC) | Bury | 8am–midnight, 7 days | 0161 918 8674 |
| Fairfield General (Frailty SDEC) | Bury | Mon–Fri 8am–8pm | 0161 778 3275 |
| Royal Oldham Hospital (Ward A2) | Oldham | Hours not explicit on public page — confirm 7-day status | 0161 656 1808 |
| Rochdale Infirmary | Rochdale | Mon–Fri 8am–9pm; wknd 10am–6pm | via GP/NWAS/UTC referral only |
| Salford Royal (SDEC2) | Salford | 7.30am–8pm, 7 days | 0161 624 0420 |
| Stepping Hill Hospital | Stockport | 8am–8pm, 7 days | 0161 419 5907 |
| Tameside General | Tameside | Referrals 8am–8pm; seen until 10pm | 0161 922 4147 |
| Trafford General | Trafford | Mon–Fri 8am–8pm | 0161 746 2011 |
| Royal Albert Edward Infirmary | Wigan | Mon–Fri 8.30am–9pm (weekend not published) | 01942 822376 |
North Manchester General SDEC provision appears folded into the MFT/Wythenshawe system rather than a standalone public page — confirm current status.
Chest Pain
National threshold — this is the actual rule, not local preference
Refer for urgent same-day assessment (i.e. SDEC-type disposition) if ACS is suspected, there's no reason for emergency referral (no ongoing pain, no red flags), AND:
- Pain within the last 12 hours but now pain-free, with a normal resting 12-lead ECG, OR
- Last episode of pain was 12–72 hours ago
Typically SDEC-appropriate (low-risk chest pain)
- Suspected ACS/PE/respiratory cause, but "fit to sit" / mobilising
- No ongoing cardiac chest pain
- No new/acute ECG changes
- Haemodynamically stable
- NEWS2 within local threshold (UHB uses NEWS >7 as a cutoff)
Typically excluded — ED/pre-alert instead
- STEMI
- New acute ECG changes (e.g. new LBBB)
- Ongoing cardiac-sounding chest pain
- Haemodynamically unstable (hypotensive, tachyarrhythmic)
- NEWS2/SEWS above local threshold
Abdominal Pain / Surgical
Key point: "medical SDEC" and "surgical SDEC/SAU" are different doors
A presentation excluded from general medical SDEC is often still accepted into a dedicated Surgical Assessment Unit — it's not a blanket rejection, it's the wrong stream. This is the likely explanation for inconsistent "accepted/not accepted" experiences with abdo pain referrals generally, appendicitis included.
Typically accepted to Surgical SDEC/SAU
- Suspected diverticulitis, pancreatitis, cholecystitis, appendicitis (acute onset, stable)
- RIF pain / suspected appendicitis (non-gynae cause)
- Suspected acutely symptomatic gallstones
- Painful hernia (non-reducible/obstructed/incarcerated/strangulated)
- Suspected bowel obstruction, stable
- Suspected (stable) visceral perforation
- Post-op complications, wound issues
Typically excluded from Surgical SDEC/SAU
- Critically unwell / level 2–3 care needs / unstable patients
- Needs immediate (category 1) operation
- Suspected severe sepsis, generalised peritonitis, massive haemorrhage
- Acutely unwell patients arriving via ambulance — flagged separately as its own exclusion at UHB
- Compromised/potentially compromised airway
- Melaena, jaundice — routed as medical, not surgical, referral
- All gynae-cause abdo pain, all pregnant patients with lower abdo pain (→ Gynae Assessment Unit instead)
Breathlessness / Asthma / COPD
Generally SDEC-appropriate
- Breathlessness with no active COVID/D&V/flu history
- Stable, "fit to sit"
"Conditions less suited" — explicit local judgement, not a hard rule
NNUH names exacerbation of asthma/COPD specifically as poorly suited to ambulatory review because of the likely need for observation, nebulisers, and oxygen — GP referrals go to AMU directly, but paramedic-referred cases go to ED first. This is presented as a clinical judgement call, not an absolute exclusion.
Hard exclusions
- T1/T2 respiratory failure
- Requiring oxygen therapy
- Asthma with peak flow <75% of best/predicted
- Active D&V/COVID/flu — infection control exclusion, not severity
Headache
Presented as genuinely borderline, not black-and-white
Most headaches are managed in primary care. Where more serious causes are suspected (needing imaging and/or LP), NNUH's default is ED first for ambulance/self-referred cases — GPs can refer straight to AMU, but "all other cases of headache are seen in ED initially." This is despite headache appearing on NHS England's own national high-volume pathway list for ambulance SDEC referral — a clear example of the national aspiration and local risk appetite not matching.
Seizures / Falls / Trauma / Stroke-TIA
Generally excluded, ED-first
- Stroke/TIA — treated as time-critical given thrombolysis/thrombectomy pathways; goes to ED for stroke nurse review, not SDEC. (Note: GM's dedicated stroke/HASU pathway supersedes this anyway — this isn't an SDEC decision at all in practice.)
- Seizures — SDEC waiting-room model isn't set up for a patient who may seize again; GP referral possible, ambulance/self-referral defaults to ED.
- Trauma, syncope, falls — initial injury assessment in ED; frailer patients can then access same-day/OPED-type services after that initial review, not instead of it.
Gynae / Early Pregnancy
Routed to Gynae Assessment Unit (a form of SDEC)
- Pregnant: hyperemesis, abdo pain, vaginal bleeding
- Non-pregnant: menstrual problems, low abdo pain (could be colorectal/appendicitis), recurring known gynae problem
- Post-gynae-op re-attendance, post-miscarriage/delivery fever/bleeding/discharge
Practical note for referral
All pregnant patients with lower abdo pain go to Gynae/Early Pregnancy Assessment, not general surgical SDEC — worth checking this routing split is mirrored at GM sites before assuming a pregnant abdo pain patient goes through the same SDEC door as a non-pregnant one.
Sources
- NHS England, Same day emergency care – service specification, 2 Sept 2024
- NHS England, Standard guidance: Ambulance clinician (on scene) referral to SDEC, v1, 15 Oct 2021
- NICE NG185 / CG95, Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis
- NHS Greater Manchester ICP, Same Day Emergency Care service pages, updated 23/10/2025
- University Hospitals Birmingham NHS FT, SDEC GP referral criteria, reviewed 25/02/2025
- Norfolk & Norwich University Hospitals NHS FT, Referrals to Medical SDEC (mSDEC)