Innovative healthcare service is transforming emergency care in the community

8 February 2018

Key points

  • Data from the first 111 days of the remodelled Physician Response Unit (PRU) shows overall savings for local health services are estimated to be £410,938
  • In that time 67% of patients have avoided a hospital trip and been treated within the community
  • Extended service was launched in September 2017 with longer operating hours, leading to a 150% increase in patients seen
  • 97.35% of patients who filled out a feedback form said they would recommend the PRU
  • PRU is staffed by senior emergency doctors and ambulance crew and carries advanced diagnostics, medication, equipment and treatments usually only found in hospitals.  It aims to treat emergency patients at home or in the community improving patient experience and freeing up hospital and ambulance services

Patients are getting specialist emergency treatment quickly and avoiding trips to hospital thanks to an innovative service launched in East London.

TonyA review of the first 111 days of a unique collaboration between London’s Air Ambulance, Barts Health NHS Trust and London Ambulance Service’s remodelled Physician Response Unit (PRU) has revealed that emergency care is being transformed for patients in East London. By taking the emergency department on the road and to the patient, 67% of patients seen have been treated and discharged at home, allowing the patient to avoid hospital and began their recovery immediately in the community. 

Staffed with a senior emergency doctor and ambulance crew member in the car, the clinical experience of the medics enables the PRU team to treat a wider range of illnesses and injuries at scene compared to ambulance crews which take many emergency patients to hospital.  Of 652 patients treated by the PRU during its first 111 days of extended service 449 patients were treated in the community.  Of these 312 would otherwise have been taken to the emergency department at hospital

The PRU carries advanced medication, equipment and treatments usually only found in hospital such as instant result blood tests, urine tests and sutures to stitch serious wounds.  This means the PRU can treat patients where they are, avoiding a trip to East London’s hospitals.

Patients have been overwhelmingly positive about being able to receive a specialist medical consultation in their own home, avoiding having to go to hospital.  

Patient Case Study

70 year old Joshua Adeleke was seen by the PRU doctor and ambulance crew after phoning 999.  On arrival the medical team found him septic, suffering from a severe and potentially life-threatening infection, and needing immediate intervention.   Using the advanced equipment the PRU carries in its rapid response vehicle, the team were able to swiftly give him intravenous antiobiotics and fluids, perform blood tests and alter some of his blood pressure medications.  Thanks to the expertise of the medics, the interventions meant Joshua could be discharged there and then with tablet antibiotics avoiding a visit to hospital.  The medics contacted his local GP surgery to ensure that Joshua’s care was continued and he had support afterwards. Joshua made a full recovery and said the service was “fantastic.  I really appreciated that I didn’t have to go to hospital.” Joshua’s treatment illustrates the great integration of care the PRU is able to provide.

Alongside increased patient satisfaction, a better experience for patients and easing pressure on busy emergency departments, the service review has also identified significant savings for health services; £410,938 was saved in the first 111 days.

Using average costs sourced from NHS Reference Costs 2015-16 (Department of Health) the review analyses the positive impact made in three areas; emergency department attendances, hospital admissions, and ambulance resources.

Impact: Emergency Department (ED) Attendances – saving of £43,056

·         The PRU team estimated that out of 449 patients that were managed in the community over 111 days, 312 patients would have likely been conveyed by ambulance to the Emergency Department.

·         At an average tariff cost of £138 per ED episode, this equates to an estimated cost saving of: £43,056

 

Impact: London Ambulance Service – saving of £73,632

·         There was an estimated reduction in 312 LAS ambulance conveyances (2.8 per day). At a unit cost of £236 this equates to an estimated cost saving of: £73,632

 

Impact: Hospital Admissions – saving of £294,250

·         In 111 days, the team estimated that 71 patients who were managed in the community would otherwise have been admitted to inpatient wards in hospital.

·         This equates to an inpatient bed occupancy reduction of 535 bed days when matching the same group of patients and the typical length-of-stay for their diagnosis, if they had been admitted to hospital

·         The cost of a non-elective inpatient bed per night at Barts Health NHS Trust is £550. Therefore this activity gives an estimated cost saving of £294,250.

 

The total saving across all three impact areas is approximately £410,938.

Consultant in Emergency Medicine at Barts Health NHS Trust & Clinical Lead for the Physician Response Unit Dr Tony Joy said;

“The data has confirmed what we hoped would happen when we gave the PRU the opportunity to operate for longer hours with closer working between all aspects of emergency healthcare provision.  The first 111 days have brought tangible benefits to patients, who have been overwhelmingly positive in their feedback.  It has also had real impact on local health services, with estimated savings of £410,938.  We are turning emergency care on its head so that emergency patients are seen in the community by senior clinicians, enabling early treatment and access to alternative pathways without the need to go to hospital.

Our next priorities are to increase further the number of patients seen daily and implement a targeted dispatch for the patients at high risk of admission.  My hope is that other areas in the UK will see how fantastic the PRU is, and look to replicate this innovative model to help even more patients receive care within their home or community, improving their experience at the same time.”

The PRU is run as a partnership between London’s Air Ambulance charity, London Ambulance Service and Barts Health NHS Trust.  London’s Air Ambulance provides the cars and some of the equipment. Barts Health NHS Trust provides the clinical governance, training, rest of the equipment and the senior doctor who works half the time in the Emergency Department of The Royal London Hospital and half the time with the PRU.  London Ambulance Service provides the emergency ambulance crew and task the service from the 999 control centre in Bow.

Malik Ramadhan, Divisional Director of Emergency Care and Medicine at Barts Health NHS Trust, said:

“The PRU has made a real difference in ensuring that patients receive the most appropriate care, meaning that only those who need to be in the Emergency Department are taken to hospital. It is vital that we look at innovative ways of caring for the ever increasing number of emergency patients coming through the doors, and effective use of the Emergency Department is important in enabling the rest of the hospital to flow efficiently. It’s also fantastic that patients have responded so well to the service.” 

London Ambulance Service Medical Director Dr Fenella Wrigley said:

“This service ensures unwell patients get the very best care from an emergency ambulance crew and doctor.  By taking the clinical expertise of the emergency department into a person’s home, we can save a patient an unnecessary hospital visit where their condition can be safely managed elsewhere. It also means more ambulances are available to respond to our sickest emergency patients.”

 

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Enquiries:

Physician Response Unit / London’s Air Ambulance

Alexandra Sutherland (Media and Public Affairs Officer)

Tel: 07772 524 602

Email: a.sutherland@londonsairambulance.co.uk

Notes to Editors:

 

Physician Response Unit

The Physician Response Unit (PRU) is a rapid response emergency service consisting of a senior doctor and London Ambulance Service clinician that aims to ‘take the Emergency Department to the patient’. It is based at The Royal London Hospital, and operated collaboratively by Barts Health NHS Trust, London’s Air Ambulance and London Ambulance Service.

The vehicle carries diagnostic equipment and treatments which would normally be found only in hospital. The service is able to diagnose and treat a wide range of emergencies in the patient’s home, avoiding hospital attendances and admissions, and enhancing patient care and experience.

Funding from Tower Hamlets Together has been provided to help remodel and extend the service.

Service improvements include;

  • Increased operational hours to 12hours/day, 7 days/week from 8 hours/day, 5 days a week
  • Focus on enhancing care and experience for emergency patients that have complex needs and are therefore ‘high-risk’ for hospital admission
  • Working more closely with primary and community healthcare providers in order to develop and
  • embed community clinical pathways
  • Developing the mobile IT system to provide access to electronic health records when at the patient’s home

 

Barts Health NHS Trust


With a turnover of £1.4 billion and a workforce of around 16,000, Barts Health is the largest NHS trust in the country, and one of Britain’s leading healthcare providers. The Trust’s five hospitals – St Bartholomew’s Hospital in the City, including the Barts Heart Centre, The Royal London Hospital in Whitechapel, Newham University Hospital in Plaistow, Whipps Cross University Hospital in Leytonstone and Mile End – deliver high quality compassionate care to the 2.5 million people of East London and beyond.

 

London’s Air Ambulance

London’s Air Ambulance is the charity that delivers an advanced trauma team to critically injured people in London.

  • It was founded in 1989 and to date has treated over 37,000 critically injured people and attended most major incidents.
  • It serves the 10 million people who live, work and travel within the M25.
  • London’s Air Ambulance is a charity that operates in partnership with both Barts Health NHS Trust and the London Ambulance Service:
  • Barts Health NHS Trust employs and remunerates the doctors who are seconded to the service, as well as providing some direct financial support and the helipad facility for the charity’s operations.
  • London Ambulance Service similarly provide paid paramedics who are seconded to the service.  An advanced trauma paramedic operates from the Service’s control room and is responsible for dispatching London’s Air Ambulance to the most critically injured people in London, 24 hours a day.