Carol Barbeler (Gippsland Region Palliative Care Consortium), Irene Murphy (Gippsland Regional Palliative Care Consultancy Service and one of the authors of the original tool) and Dr Eli Ristevski (Monash Rural Health).
There is a clear need to improve access to after-hours services for palliative care clients and carers. This has been highlighted by both the Victorian Auditor-General’s Palliative Care report (2015) and the Victorian Government’s end of life and palliative care framework (2016).
To date, in Gippsland, there has been little documented information of the demand for after-hours palliative care, the type of advice given to clients and caregivers, and the processes for a home or hospital visit.
During the past 12 months, a collaboration between Monash Rural Health, the Gippsland Region Palliative Care Consortium (GRPCC) and the Gippsland Primary Health Network, has created an electronic telephone triage tool, providing after-hours support for community palliative care clients and carers.
Together they developed a digital version of the GRPCC’s existing paper-based booklet, originally developed in 2014. Registered nurses in community palliative care and hospital settings across the Gippsland region were trained in using the electronic triage tool to support their decision-making in palliative care symptom management. Training was provided over Zoom, supported by a specially developed training program, enabling nurses to practice using the digital triage tool. Despite the interruption of COVID-19 on many health services, they were able to continue the project remotely throughout 2020 and into 2021.
The tool itself contains question prompts for symptoms and algorithms for clinical actions. Nurses completed the tool during or immediately following the telephone call from a client or caregiver and results from the calls were assessed as part of the project.
Based on five months of preliminary data between November 2020 and March 2021, evaluation of the triage tool showed that the majority of the 62 calls received were on weekdays (79 per cent) between midnight and 9 am (61 per cent). Most callers were caregivers (85 per cent) and a total of 81 symptoms were documented over the period. Common reasons for calls included communicating changes in care, setting or symptoms (27 per cent), followed by pain (20 per cent) and client anxiety or restlessness (19 per cent). The majority of issues were resolved through the phone call (44 per cent) or a nursing visit after hours (20 per cent) and only a few required ambulance transfer (4 per cent).
This preliminary data provides the first regional picture of after-hours issues for community-based palliative and end-of-life care clients and carers. It provides a better understanding of the needs of clients and carers, but also the needs of Gippsland’s health services who provide palliative care – which is critical for informing workplace training and service planning across the region. This tool ensures telephone advice is evidence-based, consistent and there is appropriate client/caregiver referral and follow-up. Guiding professionals and carers, through the use of the tool, will also likely decrease the need for emergency department admissions or subsequent hospital admissions.
In the coming months, the project team will be implementing the electronic triage tool across a greater number of services and sectors. Working with the Gippsland Primary Health Network, it will be rolled out to primary care professionals across general practice. A customised version of the tool has also been developed for the residential aged care setting. This will further strengthen after-hours support available to the Gippsland community, enabling residents to receive quality care, at any time, within the comfort of their own homes.
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