National Ambulance Service – Cork Pathfinder Team

Description

The Pathfinder service is a collaborative initiative between the National Ambulance Service (NAS) and Cork University Hospital (CUH), developed to provide an alternative care pathway for older adults who access emergency services through 999 calls. The programme aims to deliver the right care, in the right place, at the right time, reducing unnecessary hospital conveyance while improving patient outcomes and satisfaction.

Background and Development
Pathfinder originated with a pilot project in Beaumont in 2018 and was established as a permanent service there in March 2020. The Cork Pathfinder service was launched in March 2023 and has since expanded to include sites in Donegal, Galway, Limerick, Kerry, Carlow/Kilkenny, and Waterford. It reflects a growing emphasis on integrated care and the need to reduce pressure on emergency departments, particularly for frail, elderly patients.

Traditional Practice and Evidence Base
Historically, many older patients calling 999 were transported to hospital, regardless of whether admission was necessary. A retrospective study of 178 patients (average age 79, median Clinical Frailty Score (CFS) of 6) found that 69% remained at home after initial Pathfinder assessment, and 67% received follow-up care from the Pathfinder team. This highlights the service’s capacity to support safe, community-based care.
A separate qualitative study involving telephone interviews with 429 service users (75% response rate) identified five core themes regarding patient experience:
1. The professionalism of the team
2. The value of timely, appropriate care
3. Pathfinder’s role in initiating broader care pathways
4. The long-term positive impact on patients
5. The importance of skilled communication with older people

The Cork Pathfinder team consists of:
• Two Advanced Paramedics
• One Clinical Specialist and one Senior Occupational Therapist
• One Clinical Specialist and one Senior Physiotherapist
The service operates two distinct elements:
1. Rapid Response Vehicle (RRV) – Operational from 8am to 8pm, Monday to Friday, this team responds to live 999 calls involving older or frail patients. They can treat and discharge on scene, treat and follow up, or convey to ED if necessary.
2. Follow-Up Service – Patients can receive up to 7 days of continued support post-initial assessment. Interventions include:
o Home-based rehabilitation
o Equipment provision
o Falls risk assessments
o Referrals to community services

Impact and Outcomes (Year 1 & 2: April 2023 – March 2025)
In the first two years, the Cork Pathfinder RRV attended 1615 calls, of which 1165 were Pathfinder-specific and 450 were Advanced Life Support (ALS). The average patient age was 80, with a median CFS of 6 (moderate frailty). Notably, the overall non-conveyance rate was 69%, demonstrating a significant shift toward community-based care and reduced ED attendances.

Ongoing Projects and Future Plans
Several initiatives are underway to expand Pathfinder’s reach and effectiveness:
• Development of an interdisciplinary falls assessment tool
• April 2024: Expansion of referrals from CUH and Mercy University Hospital to Pathfinder teams
• August 2024: GP referral pilot involving five Cork City practices
Pathfinder continues to evolve as a critical component of integrated emergency and community care for older people.

Aim of Initiative

The primary aim of the Pathfinder Cork project is to enhance emergency healthcare delivery for older adults by providing a community-based alternative to unnecessary hospital admissions. Developed collaboratively by the National Ambulance Service (NAS) and Cork University Hospital (CUH), Pathfinder seeks to deliver the right care, in the right place, at the right time—particularly for frail, elderly patients who access emergency services through 999 calls.
Historically, older patients were routinely conveyed to emergency departments, even when alternative care pathways could have provided more appropriate support. Pathfinder addresses this by integrating pre-hospital emergency response with allied healthcare professionals, enabling on-site assessment, treatment, and follow-up in the patient’s home.
The service operates through a Rapid Response Vehicle (RRV) staffed by Advanced Paramedics and either a Senior Occupational Therapist or Senior Physiotherapist. This team responds to live emergency calls, assesses the patient, and either treats or discharges, arranges follow-up care, or conveys to hospital only when necessary. The Follow-Up Service extends care for up to seven days, including rehabilitation, equipment provision, falls risk assessments, and onward referrals to community services.
Through this model, Pathfinder aims to reduce strain on emergency departments, support older people to remain safely in their own homes, and improve patient outcomes and satisfaction. Early results show a significant non-conveyance rate (69%), demonstrating success in reducing unnecessary hospital visits. The broader vision is to reshape emergency care by embedding integrated, patient-centred services that reflect both clinical need and quality-of-life considerations.

Who is it aimed at

The Pathfinder service is a targeted initiative aimed at older adults, particularly those living with frailty, who access emergency care through 999 calls. By offering an alternative, community-based care pathway, Pathfinder ensures that this vulnerable population receives timely, appropriate care in their own homes, where safe and feasible, rather than being automatically transported to hospital. The programme is designed to improve clinical outcomes, patient satisfaction, and system efficiency, aligning with national priorities under Sláintecare to deliver integrated, person-centered care closer to home.

3 Steps critical to success

1. Strong Interdisciplinary Collaboration and Clinical Governance
   Successful delivery depends on seamless collaboration between the National Ambulance Service, acute hospitals (e.g., CUH), and allied health professionals. Clear governance structures, shared protocols, and joint training are essential to maintain the high standards of care, clinical decision-making, and follow-up that underpin Pathfinder’s effectiveness. This supports Sláinte Care’s emphasis on integrated team-based models.
2. Sustainable Resourcing and Workforce Capacity
   To meet demand and ensure continuity of care, Pathfinder requires sufficient staffing, including Advanced Paramedics, Occupational Therapists, Physiotherapists, and administrative support. Adequate funding, equipment, Vehicles and operational hours are critical to scale and sustain the service in line with Sláinte Care’s goal of shifting care from hospitals to the community.
3. Robust Referral Pathways and Community Integration
   Expanding and formalising referral mechanisms with GPs, hospitals, and community services is vital to ensure timely identification of suitable patients and seamless follow-up care. This includes digital integration, streamlined communication, and shared care planning — all of which align with Sláinte Care’s principle of delivering the right care, in the right place, at the right time.

3 Challenges in Planning / Delivery

1. Workforce Capacity and Recruitment
   The Pathfinder model depends on a highly skilled, multidisciplinary team, including Advanced Paramedics, Occupational Therapists, and Physiotherapists. Recruiting and retaining this specialised workforce—particularly across multiple geographic regions—poses a challenge, especially in the context of broader staffing shortages within health services nationally.
2. Embedding New Pathways into Traditional Emergency Care Models
   Shifting from the traditional practice of automatic hospital conveyance to a community-based care model requires significant cultural and operational change. Ensuring buy-in from frontline emergency personnel, hospital teams, and referrers (e.g. GPs and ED clinicians) is essential but may be slowed by variability in understanding, trust, or established workflows.
3. Ensuring Integration and Continuity Across Health and Community Services
   For Pathfinder to succeed, it must be seamlessly integrated into existing hospital, primary care, and community support structures. This requires robust communication systems, clear referral processes, and adequate access to follow-up services (e.g., home supports, rehab). Gaps or delays in community service capacity could undermine the timeliness and effectiveness of care, particularly post-assessment.

3 Outcomes / Benefits

1. Enhanced Patient-Centred Care and Satisfaction
   The Pathfinder service empowers older adults to receive timely, appropriate care at home, significantly improving their experience and satisfaction. A qualitative study showed strong appreciation for the professionalism, skilled communication, and the long-term positive impact of the service. This aligns with Sláinte Care’s focus on delivering care that meets the needs and preferences of individuals, particularly vulnerable populations like the frail elderly.
2. Reduced Pressure on Emergency Departments and Hospital Resources
   With a non-conveyance rate of 69%, the Pathfinder programme demonstrates a substantial reduction in unnecessary hospital admissions. This helps decongest Emergency Departments, optimising acute care resources for those most in need and supporting Sláinte Care’s aim of delivering care at the lowest level of complexity and in the community where possible.
3. Integration and Continuity of Care Across Services
   Pathfinder bridges emergency and community care by providing up to seven days of follow-up, including rehabilitation, equipment provision, and referrals to community supports. This integrated model promotes continuity of care, reduces fragmentation, and ensures older adults receive comprehensive, coordinated support — a key Sláintecare priority for long-term reform of health service delivery.