Palliative care in Northern Sydney Local Health District (NSLHD) includes sub-acute inpatient and outpatient services, hospital consulting services and community-based care. Currently, Royal North Shore, Hornsby-Ku-ring-gai, Northern Beaches, and Ryde hospitals provide inpatient consultative palliative care services, but none have capacity to directly admit patients under the palliative care team.
NSLHD has a higher proportion of elderly residents with a longer life expectancy compared to the rest of NSW. 1,2 With the population projected to surpass one million by 2029 2, the demand for palliative care in NSLHD is expected to rise significantly. Royal North Shore Hospital (RNSH) has a busy palliative and supportive care service which functions as consultative liaison service, relying on other medical teams to identify patients with palliative care needs and refer as required.
A sample dataset of inpatients at RNSH who were care type changed from acute care to palliative care during 2021-22, showed there were 299 episodes of care, with acute phase episodes accounting for 19,500 bed days. The cost analysis revealed significant variations in expenses associated with care before the palliative care type change, depending on the inpatient admitting team.
Providing expert and evidence-based palliative care
This project aims to establish an acute palliative care service with specialist admission rights. Currently, RNSH has 479 inpatient beds, with none dedicated to palliative care admissions, and operates only as a supportive and palliative care consultative liaison service.
The new acute palliative care service will offer prompt, expert and evidenced-based palliative care, supported by a dedicated team. This will improve end-of-life care by offering different channels to access palliative care, reducing emergency visits and ensuring patients get timely specialist care. It will also help to improve satisfaction and experience of non-palliative care staff in delivering palliative care, coupled with increased support for these staff in caring for patients with palliative care needs in RNSH.
Dedicated medical palliative care staff will enhance knowledge
The project began in July 2023, with the onboarding of executive sponsors and establishment of the Royal North Shore Hospital Acute Palliative Care Inpatient Service Implementation Working Group. This group includes representatives from RNSH palliative care, emergency department, patient flow, medical oncology, bereavement, and service improvement.
From August 2023-January 2024, the project team conducted a comprehensive diagnostic and solution design phase. Qualitative data was gathered through clinician and patient experience surveys and process mapping. Quantitative data was captured from models of care in other Sydney metropolitan LHDs, a RNSH death data review and financial analysis.
Stakeholder consultations were instrumental in shaping the solution design. The executive sponsors and working group reviewed 24 potential solutions, prioritising the establishment of a new acute palliative care service. This service will include dedicated medical palliative care staff for admissions and transfers of care, complemented by a clinical nurse specialist to enhance palliative care knowledge and improve patient care across RNSH wards. As no dedicated palliative care ward exists at RNSH, patients will be admitted to the wards based on clinical appropriateness, staff skill mix and bed capacity.
To facilitate service commencement in September 2024, a comprehensive model of care document has been developed. Created after extensive consultations with stakeholders, the model of care incorporates guidelines to support patient referral pathways, including direct-to-ward admissions.
View this project's poster from the Centre for Healthcare Redesign graduation August 2024.
