Pathfinder is an alternative care pathway for the older community within the Beaumount Hospital catchment area in Dublin.
Pathfinder is a Sláintecare funded project and sees the National Ambulance Service, Allied Health Professionals from Beaumont Hospital, and Dublin Fire Brigade working together to respond and treat older people in their home.
When a 112/999 emergency call is received, a staff member assess whether the response required meets the triage criteria to allow the call to access the Pathfinder Service. This innovative service enables staff treat and assess the patient as well as provide the appropriate supports and follow up care to the patient, so that the patient does not need to be transported to a busy Emergency Department to receive care.
This is proving to be a much better experience for the patient as well as for staff, as they know that the patient has received appropriate care in a timely manner.
To date Pathfinder has treated 178 older 999/112 callers at home rather than transporting them to the Emergency Department. The average age of these patients is 82 years.
Minister Donnelly said: “I am delighted that this innovative service is allowing vulnerable patients in the Beaumont Hospital catchment area avoid an unnecessary attendance to the Emergency Department, and potentially, admission to hospital.”
“Importantly, receiving treatment and support at home allows patients benefit from a mental health, clinical and functional perspective as required. This service keeps older persons in the comfort of the familiar surroundings of home where they can be managed safely and avoid unnecessary presentation to an Emergency Department.”
The service is funded through the Sláintecare Integration Fund and is changing the current model of care from one of transport to ED, to a model that treats people at the scene and provides therapeutic intervention at home and onward referral to appropriate agencies, thus avoiding an emergency presentation to hospital.
Minister Donnelly said: “The overwhelmingly positive feedback from patients and families confirm that this kind of service works for patients by addressing their care needs in a considered, compassionate way, in these unprecedented and difficult times.”
“It relieves pressure within the Emergency Departments where our frontline workers are working so hard to deliver both COVID-19 and non-COVID care safely. The Pathfinder Service supports increased ED capacity to care for other patients, by supporting this cohort of complex, frail patients at home. The service is utilising a whole network of dedicated and expert community health resources, working together to ensure patients are managed safely at home. I want to thank all of the GPs, Community Intervention Teams, Public Health Nurses, Geriatricians, and NGOs who continue to deliver expert compassionate care to our vulnerable loved ones.”
Some of the feedback from patients includes:
“A wonderful service.”
“Beautiful service for older people - If I ever had to be attended to again, I know I'll be in good hands.”
“It meant a lot to me and my wife, especially the follow ups.”
Note for the Editor:
How does the pathfinder service work?
The Pathfinder 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 frail, elderly patients.
The Ambulance Team will treat the patient at the scene as an alternative to taking them to the ED, if appropriate.
The Follow-Up team, comprising of Occupational Therapist and Physiotherapist staff, will support patients who remain 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.
Presentation to ED 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 increased hospital length of stay, increased confusion and increased mortality.
About Sláintecare
Sláintecare is the plan to reform Ireland’s health services. Sláintecare has cross-party political support, and therefore provides a unique opportunity to implement a joined-up solution to make sure people can get the right care, in the right place, at the right time.
The goal of Sláintecare is that health and social care services will be built around the need of the people, such that most illnesses and minor injuries can be treated in the community. People will be able to stay healthy in their homes and communities, only attending hospital when necessary. This will result in shorter hospital waiting times for those who need to attend hospital.
Sláintecare Integration Fund
Budget 2019 provided €20 million for the establishment of a new ring-fenced Sláintecare Integration Fund to test and scale how services can best be delivered.
The Sláintecare Integration Fund sought submissions with a focus on prevention, community care and integration of care across all health and social care settings
Finding, supporting and scaling innovative new ways of providing care is fundamental to delivering Sláintecare. The Integration Fund looked for initiatives that support the delivery of integrated care and the shift to community care in innovative new ways, helping to reduce and prevent hospital visits. This will support us in meeting our ultimate goal of reducing waiting lists and reducing waiting times.
Applications were invited which:
- Promote the engagement and empowerment of citizens in the care of their own health
- Scale and share examples of best practice and processes for chronic disease management and care of older people
- Encourage innovations in the shift of care to the community or provide hospital avoidance measures.
A total of 477 applications were received from a wide range of organisations. The process was very competitive with the fund being 9 times oversubscribed. 122 projects from across the country were successful.
The successful projects are in more than 100 locations right across the country. The project partners range from hospitals, hospital groups, Community Healthcare Organisations, Community and Voluntary Organisations, Universities and Primary Care Centres. Many successful projects will be delivered in partnership between hospitals and Community Healthcare Organisations, or hospitals and community organisations, highlighting the emphasis on integrated care and shifting care to the community.