20th Dec 2019

PRU Car

Patients in North East London are able to be seen at their home when they call 999, avoiding unnecessary trips to A&E, as our PRU service takes senior doctors and state-of-the-art medical equipment on the road.

Aswell as saving potentially thousands of trips to hospital, this innovative approach to emergency care is also saving over £500,000 year according to new research published in the Emergency Medical Journal. The PRU sees around five patients a day, three in four of those were likely to have been taken to hospital if this service did not exist.

The Physician Response Unit (PRU) is a collaboration between Barts Health NHS Trust, London’s Air Ambulance Charity and the London Ambulance Service (LAS). Based at the Royal London Hospital, the PRU responds to 999 calls as they come in and takes the emergency department directly to the patient.

It’s staffed with a senior emergency doctor and an emergency ambulance crew clinician, meaning the PRU team are able to treat a wider range of illnesses and injuries at the scene, compared to ambulance crews which more often need to take emergency patients to hospital. 

The PRU car 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.  It also has a computer with access to patients’ electronic records, allowing the team to review hospital and GP notes.

Barts Health, London’s Air Ambulance and the London Ambulance Service were the first in the UK to set up a PRU, launched in 2001. The innovative model has since been implemented across the UK, including Wales, Oxford and Lincoln, with other parts of the country also looking to develop similar services.

Dr Tony Joy, Consultant in Emergency Medicine at Barts Health NHS Trust and Clinical Lead of the PRU, said: “Emergency Departments, inpatient wards and Ambulance Services are under a lot of pressure, so the time is ripe for a service like this to be rolled out more widely.

“The Physician Response Unit takes the emergency department directly to the patient. We’re able to provide immediate patient-centred care for those who would normally need to be taken to ED. This also frees up hospital and ambulance resources, and allows us to prioritise care in ED for very sick patients.”

In early December, Charles Rumsey, aged 90 from East Ham, London, had a blocked catheter for which a district nurse advised calling 999 for hospital attention. He has advanced dementia, and he and his wife were braced for a long day at A&E. Instead, a PRU team arrived and were able to change his catheter at their home.

His wife, Valerie Rumsey, said: “I initially phoned the local nurse, who said we should call an ambulance because it needed quick attention. So I phoned 999, and we got ourselves ready to go to hospital in an ambulance.

“The response was so quick, arriving in around 10 minutes, and I was amazed when a car turned up with two medics, including a senior doctor, and an unbelievable amount of equipment. They examined Charles, and said it could be done there and then. I just couldn’t believe it. The doctor who unblocked the catheter was absolutely brilliant, and sorted everything out so quickly.

“Because my husband has advanced dementia, it meant an awful lot to us not to have to take him to hospital. It’s made us quite emotional, feeling so well looked after without having to leave the house. This should be made available to as many people as possible. A lot of people our age would benefit, and so would babies and children. Everybody would benefit, in fact.”

The latest research, published in the Emergency Medicine Journal, shows that many patients seeking emergency care via ambulance can be managed outside of hospital using the PRU:

- The PRU saw 1,924 patients over the 12 month period (September 2017-September 2018), averaging 5.3 per day, with 1,289 (67%) of patients being treated successfully in the community.

- Of those managed in the community, 945 (73%) were likely to have been taken to hospital by a standard ambulance resource.

- The PRU was estimated to deliver a reduction of 868 inpatient bed days and replaced the need for three ambulance responses per day, generating an estimated total net saving of £530,107 over the year.

- 640 patients (33%) underwent diagnostic tests not normally available with regular ambulance service resources.

- 98% of 52 patients surveyed were extremely likely to recommend the service.

Patients were overwhelmingly positive about being able to receive a specialist medical consultation in their own home, avoiding a trip to hospital. This includes the elderly and infirm where a hospital episode increases the incidence of disorientation, falls and infections.

Jonathan Jenkins, Chief Executive of London’s Air Ambulance said: “I’m incredibly proud of the innovative work Tony and everyone at the PRU are doing and the difference it is making to patients’ lives. London’s Air Ambulance Charity knows the importance of bringing the emergency department to the patient and the PRU is a crucial part of this, allowing us to do the very best for our patients. The opportunity to expand this work, both ourselves and with partners, is huge.”

The rapid response cars and some of the equipment on board are provided by London’s Air Ambulance Charity. Barts Health 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 research published in the Emergency Medical Journal was produced by a group of clinicians from Barts Health NHS Trust, including Tony Joy, Lisa Ramage ‍, Sophie Mitchinson, Oliver Kirby, Rob Greenhalgh, Danë Goodsman, and Gareth Davies, several of which work with London’s Air Ambulance Charity.