224 “OLDER PEOPLE WANT TO BE IN THEIR OWN HOMES”: THEMATIC ANALYSIS- PATIENT AND CARER FEEDBACK AFTER PATHFINDER EMERGENCY CALL RESPONSE

Background

Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is a growing evidence base for alternative care pathway models at the time of a low acuity emergency medical services (EMS) call. Previous research has found a high level of patient satisfaction with the Pathfinder model, in which an Advanced Paramedic and a Physiotherapist or Occupational Therapist respond to EMS calls [1]. However, the reasons underpinning this from a patient perspective have not previously been reported.

Methods

This is a qualitative study employing thematic analysis of open-ended responses recorded in 429 telephone interviews with service users (patients or their next-of-kin), who had been attended by the Pathfinder service following an EMS call.

Results

Five primary themes were identified: (1) the professionalism of the interdisciplinary clinical team; (2) “the right service, in the right place at the right time”; (3) the role of Pathfinder in “getting the ball rolling” through following up and co-ordinating referrals and services; (4) the lasting impact of the experience on the patient and their next-of-kin; (5) the value of skilled communication with the older person, as well as smooth and “tuned-in” communication across the team.

Conclusion

Older people voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be assessed and treated in their homes at the time of an EMS call rather than automatic conveyance to the ED. They recognised the value of a skilled interdisciplinary team, with a follow-up service, that effectively positions itself between the acute hospital and community services.

Reference

1. Bernard P, Corcoran G, Kenna L, et al. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50(5):1854–1858.

34 PATHFINDER; AN ALTERNATIVE TO THE EMERGENCY DEPARTMENT FOR OLDER PATIENTS WHO DIAL 999/112

Background

Traditionally in Ireland, people who dial 999/112 are transported to the Emergency Department (ED) unless they decline to travel. Many have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while in hospital. Alternative care pathway models can reduce ED crowding and improve patient outcomes.

Methods

This service is a collaboration between the National Ambulance Service and Occupational Therapy (OT) and Physiotherapy Departments at a Dublin teaching hospital; funded by the Sláintecare Integration fund. It responds to low acuity 999/112 calls for people 65 years and older within the hospital catchment.

The team operates Monday–Friday, a ‘Rapid Response Team’ (Advanced Paramedic and Physiotherapy/OT) (8:00–20:00) and a ‘Follow-Up Team’ (Physiotherapy and OT) (8:00–16:00).

Once activated, the ‘Rapid Response Team’ conduct a comprehensive assessment in the home to establish whether a suitable alternative to the ED is available, commonly through the activation of one or more alternative care pathways (e.g. GP, Integrated Care Team, Primary Care Team, Community Intervention Team, Geriatric Day Hospital).

Results

In the first year, 485 patients were responded to. Average age was 80 years, average Rockwood Clinical Frailty Scale score was 6 (moderately frail). The majority (68%) remained at home following initial review. Less than 1% re-presented within 24 hours, 9% re-presented within 7 days. The three most common reasons for dialling 999/112 were falls, generally unwell and non-traumatic back pain. Patient and care-giver feedback demonstrated a very high level of satisfaction with the service.

Conclusion

This model is a safe alternative to the ED for older people following a low-acuity 999/112 call. Access to a network of alternative care pathways and immediate follow-up are two key enablers. The overwhelmingly positive feedback confirms that older people want this service. It is the first model of this kind to be evaluated in Ireland, and could expand, with local adaptation, nationally.

The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine

Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.

Impact of Pharmacometric Reviews on New Drug Approval and Labeling Decisions—a Survey of 31 New Drug Applications Submitted Between 2005 and 2006

Exploratory analyses of data pertaining to pharmacokinetic, pharmacodynamic, and disease progression are often referred to as the pharmacometrics (PM) analyses. The objective of the current report is to assess the role of PM, at the Food and Drug Administration (FDA), in drug approval and labeling decisions. We surveyed the impact of PM analyses on New Drug Applications (NDAs) reviewed over 15 months in 2005-2006. The survey focused on both the approval and labeling decisions through four perspectives: clinical pharmacology primary reviewer, their team leader, the clinical team member, and the PM reviewer. A total of 31 NDAs included a PM review component. Review of NDAs involved independent quantitative evaluation by FDA pharmacometricians. PM analyses were ranked as important in regulatory decision making in over 85% of the 31 NDAs. Case studies are presented to demonstrate the applications of PM analysis.