Designing the service

 The new Surgical SDEC Unit at Ysbyty Gwynedd ensures patients receive the care they need in the right place at the right time.


SDEC is for adult ambulatory trauma patients who are referred from their GP, or who have been seen and reviewed in the Emergency Department.


This is easier for some specialties than others, and exact implementation is based upon NEWS scores being greater than 4, and clinical conversations with a senior decision maker.


The consultant led service assesses, diagnoses and treats eligible patients before discharging them home to recover or to wait for further treatment.

Who is classed as an Ambulatory Trauma patient?

They have sustained isolated injuries that follow a predictable course, such as one of the ‘Simple 6’ fractures.

They are able to get to and from hospital.

They can look after their own basic needs (or be looked after).

They will go home to sleep in their own beds.

They are not major trauma patients, such as those with polytrauma, open fractures, contaminated wounds, or high energy bone or soft tissue injuries.

They are not frail elderly patients who require major orthopaedic surgery, patients with multiple co-morbities or patients who lack safe social care.

Ambulatory Trauma Care aims to treat patients with simple, stable injuries within 24 hours, according to the following principles:

  • Ambulatory Trauma patients are treated at the Front Door, as part of a collaborative system with other Front Door specialists such as Emergency Medicine and Frailty – this model is part of Betsi Cadwaladr Health Board’s Front Door strategy, and limits unnecessary travel through hospitals.
  • Care is provided in a dedicated unit with its own nursing staff, which is part of the Trauma and Orthopaedic department.
  • Patients receive a full care package on the same day (within 24 hours) delivered under a consultant Trauma and Orthopaedic surgeon, which include:
    • Diagnosis, investigation, treatment decision, rehabilitation plans and patient advice
    • Data collection and patient communication through IT systems that facilitate governance and remote or virtual contact with patients
  • If treatment lasts longer than 24 hours this takes place in the Ambulatory Trauma unit.
  • If the patient requires an operation this is done promptly as a day case on a scheduled list.
  • Most ambulatory trauma injuries have a predictable course and treatment is standardized.
  • Patients receive guidance on their expected recovery at the time of treatment and take responsibility for their self-directed therapy and self-initiated follow-up, if required.
  • Consensus among the surgeons responsible for Ambulatory Trauma is key and should be guided by evidence, standards and guidelines for trauma.

Making this new model of health care as good as it can be requires a culture of:

Encouraging local good practice

Expecting mistakes when trying something new

Understanding and making explicit the rules of conduct

Trusting that everyone cares about the collective goal

Further information can be found in this document, which aims to help clinicians make the right diagnosis and deliver the right care to patients with one of the ‘Simple 6’ injuries. It also provides the patient information and safety netting, or ‘SOS’ procedures, to ensure patients are informed about their injury and know what to do if they have problems.