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Community emergency medicine: taking the ED to the patient: a 12-month observational analysis of activity and impact of a physician response unit
  1. Tony Joy1,
  2. Lisa Ramage1,
  3. Sophie Mitchinson1,
  4. Oliver Kirby1,2,
  5. Rob Greenhalgh1,3,
  6. Danë Goodsman3,4,
  7. Gareth Davies1,3
  1. 1Physician Response Unit, Barts Health NHS Trust, London, London, UK
  2. 2London Ambulance Service NHS Trust, London, London, UK
  3. 3London's Air Ambulance, Institute of Pre-Hospital Care, London, UK
  4. 4Medical Education, Barts and The London School of Medicine and Dentistry, London, UK
  1. Correspondence to Dr Tony Joy, Physician Response Unit, Barts Health NHS Trust, London E1 1FR, UK; tonyjoy{at}nhs.net

Abstract

Background and objectives International and national health policies advocate greater integration of emergency and community care. The Physician Response Unit (PRU) responds to 999 calls ‘taking the Emergency Department to the patient’. Operational since 2001, the service was reconfigured in September 2017. This article presents service activity data and implications for the local health economy from the first year since remodelling.

Methods A retrospective descriptive analysis of a prospectively maintained database was undertaken. Data collected included dispatch information, diagnostics and treatments undertaken, diagnosis and disposition. Treating clinical teams recorded judgments whether patients managed in the community would have been (1) conveyed to an emergency department (ED)and (2) admitted to hospital, in the absence of the PRU. Hospital Episode Statistics data and NHS referencing costs were used to estimate the monetary value of PRU activity.

Results 1924 patients were attended, averaging 5.3 per day. 1289 (67.0%) patients were managed in the community. Based on the opinion of the treating team, 945 (73.3%) would otherwise have been conveyed to hospital, and 126 (9.7%) would subsequently have been admitted. The service was estimated to deliver a reduction of 868 inpatient bed days and generate a net economic benefit of £530 107.

Conclusions The PRU model provides community emergency medical care and early patient contact with a senior clinical decision-maker. It engages with community providers in order to manage 67.0% of patients in the community. We believe the PRU offers an effective model of community emergency medicine and helps to integrate local emergency and community providers.

  • prehospital care
  • emergency care systems

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @tonyjoy81, @LisaRamage, @smitchinson1, @_Oliver_Kirby, @GreenhalghRob

  • Contributors TJ: concept and design, acquisition of data, data analysis and interpretation, manuscript draft, revision and approval. LR: concept and design, data analysis and interpretation, manuscript draft, revision and approval. SM: data analysis and interpretation, manuscript revision and approval. OK: concept, manuscript draft and approval. RG: manuscript revision and approval. GD and DG: concept, manuscript revision and approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Press release No.

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