THE PATH TO S U CCESS

The National Ambulance Service-led Path nder initiative, designed to safely keep older people who phone 999/112 at home rather than being taken to hospital, has been a huge success, according to a new paper prepared by the Royal College of Surgeons in Ireland (RCSI).

An extract of the paper titled ‘Older people want to be in their own homes: a service evaluation of patient and carer feedback a er Path nder responded to their emergency calls’ was published earlier this year in the prestigious US journal Pre-Hospital e paper describes feedback following Path nder intervention and reports an overwhelmingly positive experience for both patients and carers since the initiative was rst launched in the North Dublin area in May 2020.

Emergency Care.

Objectives

It outlines the objectives of the study as follows: “Older people experience high rates of adverse outcomes following emergency department (ED) presentation. ere is growing evidence to support alternative care pathways for certain types of emergency medical services (EMS) calls. Path nder is one such service and targets patients aged 65 years and over, whose presenting issues can be safely managed at home by immediate paramedic, occupational therapy, and/or physiotherapy interventions. e aim of this service evaluation was to understand how older people feel about being treated at home as a result of EMS calls and to understand their experience of the Path nder service.” itself between the acute hospital and community services.” e positive feedback towards the service, which sees an Ambulance Team comprising an Advanced Paramedic (AP) and a Clinical Specialist Occupational erapist (OT) or Physiotherapist (PT) responding to emergency calls from low acuity elderly patients, has seen it expand from the area around Beaumont Hospital to several other regions across Ireland, with NAS teams now operating in Tallaght, Limerick and Waterford.

Director of the HSE NAS Robert Morton said the Path nder model improves outcomes for older people by minimising unnecessary ED attendances and o ering safe supporting this cohort of complex, frail patients at home,” she said.

Necessity

e initiative has been as necessary as it has been successful, with a rising population of people over 65 years of age and increasing pressure on hospitals to accommodate the number of patients attending EDs across the country.

When the Path nder service was rst launched, the Department of Health said: “An emergency department stay of more than 12 hours increases an inpatient’s length of stay by 2.35 days. In 2018, 9,861 patients aged 75 years and over presented to Beaumont Hospital’s ED, and approximately 50% of those patients were admitted, with an average length of stay of 17 days.

Telephone interviews were conducted with 429 of 573 service users, with ve primary themes identi ed. ese were the professionalism of the multidisciplinary clinical team; “the right service in the right place at the right time”; the role of Path nder in “getting the ball rolling”; the lasting e ects of the experience on the patient and his or her next of kin; and the value of skilled communication with the older person.

Conclusion

e conclusion was that: “Older people and their next of kin voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be treated in their homes at the time of an EMS call, rather than default conveyance to the emergency department. ey appreciated the importance of a skilled multidisciplinary team with a followup service that e ectively positions alternative care for older people in their own homes.

His views were echoed by executives and management at hospitals in the regions where Path nder services have been introduced.

Response

Grace Rothwell, general manager at University Hospital Waterford, said that many older patients have nonurgent care needs that can be treated at home, adding that Path nder has been shown to be a “safe and acceptable” service for those who call 999/112 with “low acuity” complaints.

Lucy Nugent, Chief Executive at Tallaght University Hospital added that the initiative aims to reduce congestion in busy EDs and makes for a “better environment for patients and sta on the oor whilst improving overall ow through the ED.

“ e service enables increased ED capacity to care for other patients by

“Presentation to emergency departments for elderly people increases the risk for elderly patients of experiencing an adverse event, such as pressure ulcer, infection, adverse drug event, functional decline, delirium or a fall. It can result in patient dissatisfaction, increased hospital length of stay, increased confusion, and increased mortality.

“A recent review highlighted a 22% increase in presentations of over 65 years to Beaumont Hospital’s Emergency Department between 2015 and 2018. is trend is replicated amongst many Emergency Departments nationally and is predicted to increase. By 2026, there will be a 44% increase in the over 65 year population of North Dublin.

“ is project will change the current model of care from one of transport to ED to a model which treats people at the scene and provides therapeutic intervention at home and onward referral to appropriate agencies, thus avoiding an emergency presentation to hospital. ere are potentially signi cant cost savings to the health service due to a reduction in in-patient bed days, and a reduction in ED presentation and subsequent treatment of adverse events experienced.