10 February 2026
New guidelines on Extended Emergency Medicine Ambulatory Care (EEMAC) have been published by the Royal College of Emergency Medicine.
This document, which was co-authored by RCEM President Dr Higginson and Dr Rachel Hoey, Chair of RCEM’s Clinical Leadership and Service Design Committee, sets out standards and recommendations on the safe and proper use of ambulatory care beyond the 4-hour mark for Emergency Department (ED) patients.
It is designed to supplement and fill in the gaps within recently published NHSE guidance on the issue, and applies across the four UK nations where relevant.
Although not a new concept, many ambulatory and overnight units associated with EDs were phased out during the COVID-19 pandemic. The reintroduction of areas designed to provide a calmer, quieter, area for patients who may require extended care under the specialty of Emergency Medicine has potential to improve patient experience.
However, there is a significant risk of them being used to sidestep time‑based ED standards at a time when organisations are under pressure to improve performance around “quick wins.” This concern is one of the key reasons why RCEM has issued its own guidance.
Our new guidance sets out where these spaces might have a role, will help to identify which patients should be treated there, and provides advice on how to safely and effectively implement EEMAC without it being used as a way to circumvent time-based standards for EDs.
This new guidance also asserts that EEMAC must be under the responsibility of EM, so that the patients who go there, do so for the right reasons.
RCEM are also clear that EEMAC facilities should be co-located with EDs, but not carved out of existing space, and must be separately resourced so as to not detract from the existing overload of EDs. They should only be introduced following thorough discussion, and with the agreement of, EM clinicians.
The current NHSE guidance is worryingly unclear on the funding arrangements underpinning this concept, despite our efforts to seek such clarity. This missing piece of the jigsaw is important.
We have strongly urged NHSE to offer clarity on this matter, and do not support the widespread introduction of EEMAC without assurance that it will be funded and resourced properly without reductions elsewhere, in line with other forms of ambulatory care undertaken by other specialties.
The new guidance can be viewed in full here.
Dr Rachel Hoey, Chair of RCEM’s Clinical Leadership and Service Design Committee, said: “EEMAC is becoming more common across the country. Our guidance will help to ensure that it is implemented safely and effectively.
“When it works, it frees up space in ED and moves patients who are better suited elsewhere outside of this noisy and sometimes unsuitable environment.”
RCEM President Dr Ian Higginson said: “With EDs under pressure like never before, it’s crucial that we examine how we can move with the times. That holds no fear for us and we will work constructively with system leaders to innovate.
“However, it is important that innovations like EEMAC are accompanied by resources and funding to match. Without this, any potential improvements to patient care or efficiency will not happen.
“Our members, and their trusts, must be supported to implement such systems without the risk of them being misused in the pursuit of fake performance improvements, without being asked to undertake work that is not our role, without being pressured to take on extra work without appropriate resourcing, and without putting patients at risk of harm or substandard care. This guidance aims to do just that.”