183 Pathfinder emergency response to urgent urinary catheter issues in older adults; a service profile

Abstract

Abstract Background Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is growing evidence for alternative care pathways at the time of a low acuity Emergency Medical Services (EMS) call. The Pathfinder service is a collaboration between the National Ambulance Service and acute hospital Occupational Therapy and Physiotherapy Departments. The service responds to low acuity 999/112 calls for people aged 365 years within the hospitals catchment area, including low acuity calls for blocked or dislodged indwelling urinary catheters. Methods A retrospective analysis of the service’s database was completed (1/1/22–26/5/23). All of the patients seen where the reason for 999 call was recorded as ‘blocked catheter’, ‘dislodged catheter’ or ‘urinary issues’, were identified and analysed. Results One hundred patients were identified, with urinary catheter related issues. Of these patients, 70% were male. The average age was 81 years. The average Clinical Frailty Scale score was 7 (severely frail). Ninety One percent of these patients remained at home as a result of the services’ intervention at the time of the 999 call. Of these 91 patients, 54% were classified as ‘treat and discharge’ (no further input or onward referral required), and 37% were ‘treat and refer’ (with onward referral to other services including Hospital Urodynamics Team, Public Health Nursing, GP). Seventy five percent remained at home without representation at 24 hours; 90% at 7 days and 75% at 28 days. Conclusion The Pathfinder service is safely and effectively managing urgent indwelling catheter issues, at the time of a 999 call, in older peoples’ homes instead of the ED. This upskilling project was made possible by excellent cross-organisational collaboration with the Hospital Urology and Urodynamics Department. The next phase of upskilling will focus on the management of urgent suprapubic catheter related issues.