“Older People Want to Be in Their Own Homes”: A Service Evaluation of Patient and Carer Feedback after Pathfinder Responded to Their Emergency Calls

Abstract

Objective

Older people experience high rates of adverse outcomes following emergency department (ED) presentation. There is growing evidence to support alternative care pathways for certain types of emergency medical services (EMS) calls. Pathfinder 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. The 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 experiences of the Pathfinder service.

Methods

This was a thematic analysis of open-ended responses recorded from telephone interviews during routine service evaluation with service users (patients or their next-of-kin).

Results

Of 573 service users, telephone interviews were conducted with 429 (75%). Five primary themes were identified: (1) professionalism of the multidisciplinary clinical team; (2) “the right service, in the right place, at the right time”; (3) role of Pathfinder in “getting the ball rolling”; (4) lasting effects of the experience on the patient and his or her next-of-kin; (5) value of skilled communication with the older person.

Conclusion

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 ED. They appreciated the importance of a skilled multidisciplinary team with a follow-up service that effectively positions itself between the acute hospital and community services.

Acknowledgments

The Pathfinder Team would like to acknowledge the excellent organisational support and leadership provided by the joint Beaumont Hospital and National Ambulance Service Pathfinder Management Forum. The team would also extend special thanks to the Dublin Fire Brigade for their ongoing close collaboration, and the many other organisations making it possible for the team to deliver this service to older people.

Disclosure Statement

The authors have no competing interests to declare.