Objectives More than 50% of people who die in England and Wales use an ambulance at least once in their last 3 months of life, and around 50% attend the emergency department (ED). In Bradford, an estimated 1000 patients a year are not recognised as being within the last year of life and do not access palliative care services. We aimed to improve access to palliative care and reduce hospital admissions and days spent in hospital during the last year of life. Methods We created the Responsive Emergency Assessment and Community Team (REACT), comprised of both ED palliative medicine in-reach and a community virtual ward. The virtual ward accepts patients as ‘step-down’ from the hospital and ‘step-up’ from primary care to avoid hospital admissions through intensive holistic support. Results Between June 2022 and March 2025, REACT received 1656 referrals. Within the last 12 months, 83% of referrals received face-to-face review. 64% of patients seen by the service had a non-cancer palliative diagnosis, and those seen by REACT were representative of the local population both by ethnicity and by deprivation index. By March 2025, patients known to REACT had a reduction in the number of days spent in hospital in the last year of life by 55%. Conclusions REACT has a valuable impact on patient care, autonomy, quality of life and reduces health inequity for patients with life-limiting illnesses. By reducing time spent in the hospital in the last year of life, the service creates additional capacity across the entire healthcare system.
Holdsworth et al. (Wed,) studied this question.