The PRU is a pioneering Community Emergency Medicine service which aims to deliver safe, effective and patient-centred emergency care in North East London. It is delivered in partnership with Barts Health NHS Trust, London’s Air Ambulance Charity and the London Ambulance Service.
Essentially, the PRU brings the Emergency Department to the patient. In doing so, it provides definitive clinical assessment and management whilst harnessing the unique opportunity to see patients in the community - often in their own homes with insight into any challenges related to support networks, daily activities and access to services - to deliver urgent and emergency care which is holistic and accurately matches their needs.
The PRU strives to promote a shared decision-making model which empowers patients and facilitates clinicians to identify the right care, in the right place, and at the right time for that particular patient. It is not motivated by admissions avoidance or trying to, at all costs, manage patients at home, though the advanced equipment and senior clinicians of the PRU does, in the majority of cases, mean that patients are able to stay in their community and do not have to go to hospital.
The current operating model of the PRU involves a rapid response vehicle, senior emergency medicine doctor and ambulance clinician which attend emergency calls in the pre-hospital environment. The vehicle carries an extensive kit consisting of diagnostic equipment and emergency treatments often only found in a hospital.
These emergency calls may be referred to the PRU via 999 (primary dispatch), the London Ambulance Service crew requests or other healthcare professional referrals e.g. GPs, community services, front door hubs and speciality hotlines.
The PRU currently operates in North East London within the footprint of the three Barts Health NHS Emergency Departments: The Royal London Hospital, Newham University Hospital and Whipps Cross Hospital. Since 2020 it also offers support within the neighbouring boroughs of Barking, Havering and Redbridge.
The service sees patients of all ages with a variety of emergency presentations - from cardiac arrests, major trauma and sepsis through to severe headache, chest pain and minor injuries. The results of socio-economic deprivation are often seen in the form of loneliness, mental health crises, illicit substance misuse and difficulties in access to primary and social care. The case load is truly representative of the spectrum of cases encountered in the emergency department.
Addressing the discrepancy between resources and demand in healthcare requires real innovation to develop new models of care and new ways of working. This is exacerbated by the unique challenges associated with parts of North, Central and East London which the PRU serves. Whilst the patient is at the heart of everything the PRU does and the primary aim is always to enhance overall patient well-being and experience, indirect benefits to the wider healthcare system are apparent in the form of:
1. Organisational - greater cross-disciplinary working and integration of services
2. Workforce - improved learning and development of emergency clinicians from various disciplines with subsequent impact on recruitment and retention to the region
3. Cost - by bringing a senior decision maker to the community, ambulance conveyances, emergency department attendances and inpatient bed occupancy may be minimised where appropriate
4. Estates - reduced footfall through the emergency department and acute inpatient beds reduces overcrowding and exit-block - particularly at a time where these would have ramifications on infection control
During the COVID-19 pandemic, the PRU expanded its working hours and staffed a further two rapid response vehicles. It is now operational between 08:00-23:00 all year round. The service also supported the front door response across Barts Health by providing community monitoring, critical care and end of life care to patients suffering from the most serious complications of COVID-19.
Finally, the PRU developed pathways with oncology and palliative services within its footprint to ensure the most vulnerable members of our community had access to high quality urgent and emergency care whilst minimising their risk of exposure to COVID-19.
The PRU follows the same governance structure as London’s Air Ambulance and both services are founded on the premise of taking the hospital to the patient. However as described above, the majority of the PRU’s caseload is not from major trauma, whilst London’s Air Ambulance only responds to trauma cases.