Pathfinder Service - A new way to care for elderly people making 999 calls

At present all patients attended to by the National Ambulance Service are transported to

the Emergency Department (ED), unless the patient refuses transport to an emergency department.

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.

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.

Pathfinder is a new service run by Beaumont Hospital and the National Ambulance Service,

serving the Beaumont Hospital catchment area in North Dublin, serving, with a population

of some 290,000 people, and is funded through the Sláintecare Integration Fund.

The aim of the Pathfinder Service is to change the current model of conveyance to

the Emergency Department (ED) following a 999 call for over 65 year olds. This service

will see an ‘Ambulance Team’, comprising an Advanced Paramedic (AP) and a Clinical

Specialist Occupational Therapist (OT) or Physiotherapist (PT) responding to 999 calls from

low acuity elderly patients. It is hoped that implementation of a service like this will

minimise the number of unnecessary attendances to the ED which can be detrimental to

older people.

The Ambulance Team will treat patients at the scene as an alternative to emergency departments conveyance, if appropriate. The Follow-Up team, comprised of Occupational Therapy and Physical Therapy staff, will support patients who remained at home by providing further assessment and interventions such as provision of equipment for the home, and linking the patient in with appropriate community health and social care services provided through the HSE or voluntary agencies operating in the area.

A recent review highlighted a 22% increase in presentations of over 65 years to

Beaumont Hospital’s Emergency Department between 2015 and 2018. This 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.

This project will respond to 999/112 calls by elderly patients in an innovative way. It 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. There are potentially significant cost savings to the health service due to:

• Reduction in inpatient bed days
• Reduction in ED presentation and subsequent treatment of adverse events

experienced.