Delivering palliative care virtually

Southern NSW Palliative Care Services provide consultative medical, nursing and allied health support to people with complex physical, psychological and social issues and their families. Care is provided across acute and subacute hospital settings and in the patient’s home, including residential care facilities. Patients are not admitted to acute facilities under a palliative care specialist – they are admitted under a facility’s senior medical officer on duty.

There are no dedicated palliative care inpatient beds or staffing in Southern NSW Local Health District (SNSWLHD) acute facilities. The specialist teams are staffed by nurse practitioners and palliative care nurses who have undertaken training and education specific to the specialty. Some teams include palliative care social workers. Medical services are contracted, and other allied health services are accessible within the district.

Virtual

Nurse led

MDT input, care planning, symptom management and support to death

After hours support

Virtual care modalities are used to support the delivery of palliative care services across the district. Virtual care can be delivered via telephone, videoconferencing (e.g., myVirtualCare, PEXIP) and store and forward. This can support:

• Consultations at home or in a local health district care setting with a multidisciplinary clinical team, the patient and their family.
• Multidisciplinary team meetings, without the patient.
• Medical Outreach Programs such as HammondCare provide specialist palliative care medical input to support care delivery in SNSWLHD. This includes participating in consultations with patients in their home or other care settings, participating in multidisciplinary team meetings (in-hours) and after-hours support.
• Store and forward: taking photos and emails and sending them to clinicians for advice.

How it makes a difference

The uptake of virtual care modalities to support the delivery of palliative care services has increased steadily since 2020. Patients, carers and staff have appreciated the advantages offered by virtual care.

Patient and carer experience

• Patients have been very accepting of the technology. They can avoid travelling significant distances from home and like care being brought to their home.

• The ability to involve the patient’s general practitioner (GP) in the consultation has been of great benefit to the patient’s care and ongoing management of their symptoms.
• Virtual care enables the patient's family and carers to be involved in the consultation on the days they are unable to attend in person.

Staff experience

• Virtual technology gives clinicians the option to conduct patient consultations remotely.
• It reduces the necessity to travel long distances to hold these appointments.

• Although this is not always appropriate, virtual care can be useful to accommodate patient/clinician schedules.
• There is capacity to involve all clinicians in patient consultations and multidisciplinary team meetings using virtual care because not everyone needs to be co-located.
• Staff were provided with the training and equipment required to support implementation of virtual care modalities in their work.

What tips do you have for others?

• Ongoing education and support to provide virtual care and use the technology is required. Contact your local virtual care manager early for support and advice.

• Virtual care needs to be incorporated into the orientation given to new staff and reinforced at all levels of the organisation.
• Ongoing education and support are required to reinforce the importance of recording all occasions of service and the modality used. This will ensure non-admitted patient data accurately reflects the activities of the service.
• When involving GPs in patient consultations or multidisciplinary team meetings, ensure they are booked in advance to enable them to attend and attract payment from Medicare.
• From the beginning of the service, plan to capture district and service-specific patient experience measures. This will ensure that you collect real-time feedback from patients on their experience of care. This is powerful in supporting a patient-centred approach using the feedback to adjust service offerings and supporting adoption of virtual care.