Extended Hours Community Palliative Care Service

The HammondCare Community Palliative Care Service is provided from three separate sites covering the metropolitan health district: Greenwich, Neringah and Northern Beaches. It can refer directly to two inpatient palliative care units, Greenwich and Neringah. It also provides 24/7 specialist advice to other healthcare professionals who may call for management advice .

The community palliative care team works alongside a range of providers, including the Northern Sydney Home Nursing Service (part of Northern Sydney Local Health District), a local community nursing service; the Department of Veterans Affairs–approved providers; My Aged Care providers; and other community services such as the Aged Care Rapid Response team.

At the time of the pilot presented in this initiative, the community palliative care teams were made up of medical, nursing and allied health staff.

Nurse led

Consultative service – conducting phone calls and home visits

After-hours advice

Continuity of care planning

This local initiative focuses on a six-month pilot (between September 2017 and March 2018) that required the community palliative care service nurses to amend their work schedule to cover weekends, with the ability to take after-hours calls and provide home visits (if required).

This new service was known as the Extended Hours Palliative Care Service (EHPCS). It began with the creation of a toll-free 1800 number, which could be diverted to any mobile phone. Nurses in receipt of extended hour phone calls were required to keep a log of all the calls, what they were about, the outcome and their subjective assessment of the success of the call.

The pilot of the extended hours palliative care model saw the specialist palliative care community nurses working on weekends to answer the calls and to make calls to patients in the community of concern in the unstable, deteriorating or terminal phase (according to Palliative Care Outcomes Collaborative [PCOC]).

What difference did EHPCS make?

The EHPCS reduced the number of patients being sent to acute hospitals from 23% to 5%. There was a 50% increase in after-hours palliative care unit admissions during the EHPCS period, equating to an extra 22 people avoiding acute hospitalisation. Using an acute hospital bed cost ($2,081 per bed per day1), this represents  a saving of $45,782 to the acute hospital budget over six months and an increase in HammondCare bed occupancy.

The immediate outcome of each occasion of service was recorded for all calls. The primary goal of avoiding acute hospitalisation was achieved for 85% of callers.

Useful tips

• Prepare the staff adequately with consultation, education and mentoring
• Develop resources that staff can easily access.
• Educate all staff in any setting to:
  • Document clearly goals of care, and
  • Use ISBAR to communicate.
• Identify champions of the model.