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  1. Article ; Online: "Older People Want to Be in Their Own Homes": A Service Evaluation of Patient and Carer Feedback after Pathfinder Responded to Their Emergency Calls.

    Corcoran, Grace / Bernard, Paul / Kenna, Lawrence / Malone, Ailish / Horgan, Frances / O'Brien, Claire / Ward, Peter / Howard, Willie / Hogan, Laura / Mooney, Rebecca / Masterson, Siobhan

    Prehospital emergency care

    2023  Volume 27, Issue 7, Page(s) 866–874

    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 ...

    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.
    MeSH term(s) Male ; Female ; Humans ; Aged ; Emergency Medical Services ; Caregivers ; Feedback ; Emergency Service, Hospital ; Emergency Medical Technicians
    Language English
    Publishing date 2023-01-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.1080/10903127.2023.2168094
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis.

    Bernard, Paul / Corcoran, Grace / Kenna, Lawrence / O'Brien, Claire / Ward, Peter / Howard, William / Hogan, Laura / Mooney, Rebecca / Masterson, Siobhan

    Age and ageing

    2021  Volume 50, Issue 5, Page(s) 1854–1858

    Abstract: Background: many patients brought to emergency departments (EDs) following an emergency medical services (EMS) call have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while attending the ED. ...

    Abstract Background: many patients brought to emergency departments (EDs) following an emergency medical services (EMS) call have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while attending the ED. Alternative care pathway models can reduce ED crowding and improve outcomes. Internationally, there is no consensus on which model is recommended.
    Aim: the aim of this study is to investigate the impact of the Pathfinder model on ED conveyance rates and patient safety.
    Methods: the Pathfinder service is a collaboration between the National Ambulance Service and Beaumont Hospital Occupational Therapy and Physiotherapy Departments. It is supported by the Government of Ireland's Sláintecare Integration fund. This is a retrospective cohort study of the Pathfinder service over a 5-month period.
    Results: one-hundred and seventy-eight patients were responded to by the Pathfinder 'Rapid Response Team'. Average age was 79.6 years (standard deviation 7.6), median clinical frailty score was 6 (interquartile range: 5-6). Sixty-four percent remained at home following initial review. None re-presented to the ED within 24 hours, and 10% re-presented within 7 days. The majority (67%) of patients required follow-up by the Pathfinder 'Follow-Up Team' and/or another community-based service. Feedback demonstrates 99% patient satisfaction with the service.
    Conclusion: the Pathfinder service is a safe alternative to ED conveyance for older people following an EMS call. It is the first model of this kind to be evaluated in Ireland. The overwhelmingly positive feedback confirms that older people want this service. This model could expand, with local adaptation, nationally and internationally.
    MeSH term(s) Aged ; Ambulances ; Emergency Medical Services ; Emergency Service, Hospital ; Frailty/diagnosis ; Frailty/therapy ; Humans ; Retrospective Studies
    Language English
    Publishing date 2021-06-09
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afab095
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Core requirements of frailty screening in the emergency department: an international Delphi consensus study.

    Moloney, Elizabeth / O'Donovan, Mark R / Carpenter, Christopher R / Salvi, Fabio / Dent, Elsa / Mooijaart, Simon / Hoogendijk, Emiel O / Woo, Jean / Morley, John / Hubbard, Ruth E / Cesari, Matteo / Ahern, Emer / Romero-Ortuno, Roman / Mcnamara, Rosa / O'Keefe, Anne / Healy, Ann / Heeren, Pieter / Mcloughlin, Darren / Deasy, Conor /
    Martin, Louise / Brousseau, Audrey Anne / Sezgin, Duygu / Bernard, Paul / Mcloughlin, Kara / Sri-On, Jiraporn / Melady, Don / Edge, Lucinda / O'Shaughnessy, Ide / Van Damme, Jill / Cardona, Magnolia / Kirby, Jennifer / Southerland, Lauren / Costa, Andrew / Sinclair, Douglas / Maxwell, Cathy / Doyle, Marie / Lewis, Ebony / Corcoran, Grace / Eagles, Debra / Dockery, Frances / Conroy, Simon / Timmons, Suzanne / O'Caoimh, Rónán

    Age and ageing

    2024  Volume 53, Issue 2

    Abstract: Introduction: Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate ... ...

    Abstract Introduction: Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study.
    Methods: A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors.
    Results: In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include.
    Conclusions: Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.
    MeSH term(s) Humans ; Frailty/diagnosis ; Delphi Technique ; Consensus ; Risk Factors ; Emergency Service, Hospital
    Language English
    Publishing date 2024-02-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afae013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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