Care planning for paediatric palliative care (PPC) patients and families, requires consideration of what care they would want in a crisis, when Triple Zero (000) is called. Communicating the families agreed upon goals, preferences and individualised care needs, ensures that the whole care team, including NSW Ambulance clinicians, feel confident in the care that they are providing.
The current state of sharing information, supporting clinicians, and coordinating unplanned PPC care is complex, unintegrated and siloed across care teams. This creates inefficiencies in the system, reduces clinician confidence, and potentially results in a suboptimal experience for care providers. The Triple Zero Paediatric Palliative Care Ambulance Project aims to improve the experience, integration, and continuum of healthcare for paediatric palliative patients and families when accessing care via a 000 call. It is a collaboration between the Sydney Children’s Hospitals Network (SCHN), NSW Ambulance and NSW Ministry of Health. The project goals are to:
- gain a deeper understanding of the experience of parents and carers
- increase confidence (62% to >90%) of SCHN PPC and medical practitioners that the right coordinated care is provided to PPC patients in circumstances where unplanned care is required by June 2025.
- improve confidence (66% to >90%) of Ambulance clinicians that their decisions are informed and patient-centred by June 2025.
Broad consultation to capture stakeholder needs
Comprehensive consultation was conducted with a range of stakeholders, including NSW Ambulance clinicians, specialist SCHN PPC clinicians, other care providers and teams, program managers and bereaved family members. From these consultations, multiple actions were identified, including:
- ensuring that patient, parents, and carers experiences are considered in decision-making and advance care planning
- facilitating improved access to specialist paediatric palliative care team advice for NSW Ambulance clinicians
- providing reassurance to SCHN staff that patients care needs will be communicated and met according to their wishes when Triple Zero (000) is called
- enabling prompt and effective care coordination across all settings and care teams involved in the crisis care of a PPC patient and family
- development of an integrated system, to share valid and contemporary information.
Implementation of solutions will commence in April 2024. From a project perspective, there have been significant challenges working across three organisations, due to different processes, speciality areas and service needs. In planning for implementation, understanding this complexity has been key to designing effective and sustainable solutions. Further, unavoidable challenges presented due to workplace restructures, changes in reporting lines and balancing personal priorities, which required the team to pivot and adjust timelines. As a team, fluidly reprioritising and sharing roles as challenges arose enabled the team to adapt and respond. Broad and regular consultation with a range of stakeholders across organisations, local health districts, community care providers, clinical and role specialties and consumers, ensured that the solutions designed addresses all needs, at a systems level.
Despite these challenges, this project has led to broader benefits due to working together, increasing the understanding of each other’s perspective and roles, and building enduring organisational relationships. The benefits realised through this project demonstrate the importance of adopting a whole of health system approach in providing individualised care, which integrates across care teams, place of care and point in illness.
View this project's poster from the Centre for Healthcare Redesign graduation May 2024.
