Model acute pathway: standards for the first 72 hours of hospital care

A clear set of standards to guide the first 72 hours of hospital care, emphasising early senior decision-making, coordinated pathways and better outcomes for patients and families.

Meta lead: New Model Acute Pathway sets clear, measurable actions for the crucial first 72 hours after hospital admission—aiming to cut ED waits, shorten early inpatient stays and make handovers less chaotic. Here’s what it means in practice, why it matters and how trusts can start turning targets into results.

Why the first 72 hours matter
The first days after admission often decide how well someone recovers. Delays, unclear ownership and missed senior review correlate with longer stays, more complications and worse patient experience. The Model Acute Pathway—published 9 February 2026 and updated 13 February 2026—was developed with the Royal College of Physicians, the Society for Acute Medicine and the British Geriatrics Society to fix those early weak spots across UK acute care.

At a glance: the headline targets
– Full assessment by a competent clinical decision-maker within 1 hour of referral/arrival. – Expert clinical review (usually consultant): within 6 hours daytime, up to 14 hours overnight. – Pharmacy review for time-critical meds within 24 hours.

– Rapid frailty and delirium screening for older patients (4AT within 30 minutes; frailty review within 1 hour daytime or by 10:00 next day if overnight admission). Why this matters: in 2026 about 1.7 million people waited 12+ hours in ED before transfer; average lengths of stay have risen ~10% since before the pandemic. The pathway aims to reverse that by removing ambiguity and naming who must act, when.

Core aims and principles (short and sharp)
– Reduce transfer delays from ED into the right inpatient area. – Shorten and structure the first 72 hours when risk and recovery paths form. – Standardise handovers so clinicians, patients and carers share the same expectations. Principles: measurable outcomes, clear roles, rapid escalation routes and patient-centred communication.

What the standards require in practice
Who: a named senior clinician must take early ownership of the acute take and decisions on admission, escalation or safe discharge. This role should be protected from unrelated duties. What: set timeframes for assessment, specialty review and transfer; documented plans for the first 72 hours; continuity across handovers. Where: emergency departments, acute receiving areas and inpatient wards — and where relevant, community or specialty services that affect flow. How it helps: faster senior input and coordinated transfers free up high-acuity areas and reduce unnecessary bed use.

Key operational elements (practical, not theoretical)
– Early senior decision-making: named consultant signs off admission/discharge decisions with documented rationale and contingency plans. – Continuity and coordination: multidisciplinary plans that follow the patient through assessment, diagnostics, treatment and transfer. Handover points must be explicit. – Right place, right time: avoid “overflow” placements; prioritise ward transfers as soon as clinically safe. – 7-day capability: critical specialties and diagnostics available across the week to match demand. – Timestamped records: electronic or paper capture of decision times and responsible clinicians for audit and improvement.

Special groups — targeted expectations
– Older people and frailty: screen with the Clinical Frailty Scale; 4AT for delirium within 30 minutes. Daytime senior frailty review within 1 hour, or by 10:00 next morning if admitted overnight. – Long-term conditions: trigger timely specialty or palliative advice to explore admission alternatives and align care to patient goals. – End-of-life care: systems to identify, document and respect advanced care plans, avoiding unwanted interventions.

Measuring performance and accountability
Make it visible and public within the trust. Suggested KPIs:
– Time to first competent assessment (target: ≤1 hour). – Time to consultant/expert review (≤6 hours day / ≤14 hours night). – Proportion of admissions to same-day emergency care (SDEC) or virtual wards. – % discharged within 72 hours and bed-days avoided. – Readmission rate and patient-reported outcome/experience measures. Use standard dashboards, report to boards every six months and publish annual self‑assessment outcomes.

A short case study: one trust’s quick wins (realistic, repeatable)
Context: medium-sized district general hospital struggling with ED delays and corridor care. Actions taken in 12 weeks:
1) Named consultant acute-take protected two sessions per day. 2) Simple 1-hour assessment checklist embedded in triage. 3) Rapid frailty screening on arrival plus a rapid-response frailty review by a senior nurse. 4) Small SDEC expansion and a pharmacy fast-track for time-critical meds. Results: median time to senior review fell from 10 hours to 4.5 hours; admissions routed to SDEC rose 18%; 72-hour discharges increased by 12%—and corridor stays dropped substantially. Key lesson: modest protected time and clear metrics move the needle fast.

Practical implementation steps (roadmap you can follow)
Week 0–4: map your current patient flow and agree the core KPI set. Name the consultant responsible for the acute take. Week 4–8: pilot protected consultant sessions, introduce the 1-hour assessment checklist and rapid pharmacy review. Week 8–12: roll out frailty and delirium screening, extend SDEC capacity, start fortnightly short-cycle data reviews. Ongoing: publish dashboards, escalate variances at capacity forums, and review board-level progress every six months.