Community emergency medicine: taking the ED to the patient: a 12-month observational analysis of activity and impact of a physician response unit

Abstract

Background and objectivesInternational 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.MethodsA 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.Results1924 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.ConclusionsThe 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.

The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

“…With a 68% non-conveyance rate, our data demonstrates that an APP Team is an effective model to reduce conveyances to hospital. This is consistent with the 67% non-conveyance rate reported by London's Air Ambulance Physician Response Unit [23]. This patient-centred care assists in releasing emergency ambulances back into the system and relieving pressure on Emergency Departments.…”

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

“…– Community-based follow-up care: social work [ 55 120 121 122 ], home care nursing [ 56 121 ], diabetes clinics [ 79 80 ], falls prevention teams [ 75 77 ] and mental health facilities [ 57 59 123 124 125 ]…”

Pre-emptive emergency service—Preventive missions and promotion of health literacy at the intersections with emergency medical services

“…Weiterhin sind Ansätze denkbar, ambulante hausärztliche Versorgung an den Rettungsdienst anzubinden, um auf diese Weise ausgewählte Patientinnen und Patienten in der Häuslichkeit aufzusuchen [41].…”