Barts Health NHS Trust – taking the Emergency Department to patients

Response Unit Staff with emergency vehicle

 

Key points

 

·        Emergency patients saved a trip to hospital with new seven-day service

·        Physician Response Unit staffed by emergency doctors and an ambulance crew will carry advanced medication, equipment and treatments usually only found in hospitals

·        Service takes the emergency department to the patient, bringing care quicker and freeing up hospital and ambulance resources

Emergency medicine is heading out on the road to provide seven-day hospital care in homes and communities across east London for the first time.

London’s Air Ambulance, London Ambulance Service, and Barts Health NHS Trust have remodelled their Physician Response Unit (PRU) service to enable around 50 per cent more patients to be seen each day. More patients will get the care they need quicker, freeing up hospital and ambulance resources.

The Physician Response Unit’s emergency doctors and ambulance crew will respond to callers needing emergency care. With a senior doctor on board, the clinical experience of the medical crew 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.  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.

By enabling patients to remain at home the PRU not only cuts treatment times by hours but focuses on improving patients’ experience compared to the normal route of being admitted via the Emergency Department to hospital wards.  Feedback from patients has shown that this aspect of the service is particularly valued.  By avoiding hospital people can recover in their home or community and avoid any associated risks that can come from extended hospital stays.  For example people over 80 experience 40 per cent muscle loss for every 10 days of bed rest, putting them at increased risk of falls, skin damage and associated infection.

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

“This is an exciting time for emergency care in London.  The PRU is an innovative solution to help us respond to the very high demand on health services.  The redevelopment will mean longer operational hours, and closer working between all aspects of healthcare provision.  It turns 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.

“It will help reduce pressure on Emergency Departments by reducing admissions and will support London Ambulance Service by reducing the need for ambulance conveyances.  We hope that this model of care will be rolled out throughout the UK one day.

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.

The PRU is run as a partnership between London’s Air Ambulance, 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.

The PRU has existed for 15 years but thanks to funding from Tower Hamlets Together, and support from key stakeholders, it is now operational all year round; 12 hours per day, 7 days per week.  This is a significant rise from the previous 8 hours per day, 5 days per week service.  Additional enhancements also include a mobile IT system able to provide instant access to electronic health records when on scene to support clinical decision-making.

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

“It is vital that we look at innovative ways of caring for the ever increasing number of emergency patients coming through the doors of A&Es. Just as we are now able to safely book some A&E patients in for a next-day scan, saving them from an unnecessary overnight stay in hospital, it is often more favorable to patients to receive the care they need without having to come to hospital at all. This also keeps hospital beds free for those most urgently in need and operations running on time which is better for patients and more cost-effective for the NHS.”

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.”

The PRU is a collaborative service between the London’s Air Ambulance charity, Barts Health NHS Trust and the London Ambulance Service.