Have the Urgent Community Response Team been able to keep frail patients with head injury on blood thinners at home and reduce ED attendances?

Background:
A new guideline was implemented in Warwick to reduce unnecessary ED attendances for frail patients in the community following falls with head injuries on blood thinner medications.

Prior to December 2025, patients in the community with falls and head injuries on blood thinners were typically conveyed to ED via ambulance for clinical review and CT imaging and they bypassed a review from the Urgent Community Response (UCR) Team.

A new UCR Falls Response guideline was implemented from December 2025. The major change was that the UCR team were now allowed to review this patient group. If there was any clinical concern, the patient would be conveyed to ED. Otherwise, the patient would remain at their place of residence and the blood thinner would be paused for 7 days and monitoring advice was given. 

Results:

Following the implementation of the guideline, it was found that 68 out of the 188 patients attended to by UCR for falls over a 2-month period were on blood thinners. 17 of the 68 patients sustained a head injury. Of these seventeen patients, seven remained at home following a UCR assessment. UCR called the ambulance for six of these patients. For four out of seventeen patients, UCR initially decided to keep patient at home but later they became more unwell requiring ED attendance. 

Conclusions:

The UCR Falls Response Guidelines had the positive impact of keeping seven frail patients at home over a 2-month period which amounted to 41% of all frail patients who had fallen with head injury on blood thinners. This has a significant impact on an individual level and in the long term will reduce health care costs and strain on tertiary services in the local area. There is also scope for wider implementation of these guidelines on a national level.