Pathfinder and APP teams cared for 800+ patients at home in 2024

Two rapid-response initiatives involving National Ambulance Service and HSE Mid West hospital staff last year provided care and support at home to more than eight hundred 999/112 callers who otherwise would have been taken to the busy Emergency Department at University Hospital Limerick (UHL).

A total of 838 or 58% of 1,445 patients referred to the Pathfinder and Alternative Prehospital-care Pathway (APP) services received hospital-standard at home or in their communities without having to be brought to ED in 2024.

Pathfinder responds to 999/112 calls from people aged 65 and older who may have fallen at home or become generally unwell. The team supported 329 patients of the 506 calls referred to the team last year – a 65% ED avoidance rate.

The APP service for low-acuity emergency calls received 939 calls in total last year, and supported 505 (53.7%) patients, keeping those patients out of the ED while reducing the need for ambulance conveyance and freeing up response vehicles for critically ill and injured patients.

On Pathfinder calls, patients are assessed by an advanced paramedic and occupational therapist or a physiotherapist. Suitable patients are linked with alternative hospital and community services and a follow-up team provides immediate home-based rehab, equipment and case management in the days following the patient’s 999/112 call.

APP operates from the NAS Base in Dooradoyle, with an Emergency Medicine Registrar and a NAS Emergency Medical Technician responding in a NAS vehicle to appropriate calls within a 45-minute travel radius, five days a week, 10am-8pm. The APP team provides hospital standard care to patients at home, or makes referrals to the appropriate community or specialist service.

Limerick resident Catherine Smith’s father suffered a fall while staying at her home. She dialled 999, having never heard of Pathfinder when the emergency operator told her they were sending the response team.

Niall Murray, General Manager, Area Operations, National Ambulance Service, said: "Pathfinder and APP are a key part of transforming how we deliver pre-hospital emergency care in the Mid-West, ensuring that patients receive the right care, in the right place, at the right time. By reducing ED visits, we’re not only improving patient outcomes but also freeing up critical hospital and ambulance resources for those who need them most. The growth in demand for these services shows their value, and we look forward to expanding their impact even further."

Shirley Real, Pathfinder & Allied Health Lead, Acute Hospitals, HSE Mid West, said: “We are delighted to see the growth in Pathfinder activity. We know that older adults are particularly at risk and have associated negative outcomes from lengthy wait times in ED settings. These can include functional decline and cognitive decline, as well as exposure to a noisy, stressful hospital environment. Health and social care professionals have been at the heart of developing alternative care pathways and admissions avoidance, such as the Geriatric Emergency Medicine Unit at UHL.”

Dr Sarah Hayden, Clinical Lead for APP, said: “Increasing demand for emergency care means we have had to come up with new and innovative ways of providing it. The APP car service is just one initiative that allows us to provide the right care in the right place at the right time. This means patients receive their care in the community in their own home when appropriate. Providing patient-centred care in the community and at home for those who do not need to be in the Emergency Department is the main priority. This allows us more access to resources in the ED for those who need them.”