Examination and Analysis of After-Hours Calls in Hospice

Mayahara, Masako; Fogg, Louis

doi:10.1177/1049909119900377

Cited by 7 publications

(21 citation statements)

References 13 publications

(17 reference statements)

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“…Eight emergency issues were flagged as prevalent, and several minor medical issues were consistently raised. Given the need to triage for hospital admission (or render initial management) mentioned before and big role of phone-based support (at least till the next workday), customised staff training including resource aides could be produced [7,12,17]. Second, like others before [5,12], work improvement efforts around better 'in-hours' communication to reduce the need to 'clarify care plans' (17.6% of calls) and deliberate advice on procedures after death to minimise calls 'informing that patient has died' (10.5% of calls) are worth looking into [7,15,19].…”

Section: Discussionmentioning

confidence: 99%

“…Operating a 24/7 telephone helpline is fundamentally how most services render out of hours support. Resource considerations manning these helplines and its toll on designated healthcare staff have been acknowledged [9,10], but current evidence reveals little beyond different reasons for seeking urgent assistance while receiving hospice support at home [7,[11][12][13][14][15][16]. It is unclear how individual calls outside normal work hours are managed in a full suite service that also provides emergency home visits.…”

Section: Introductionmentioning

confidence: 99%

“…Healthcare providers however are divided on whether after-hours support rendered by an on-call team is utilised appropriately. While a few services have reported underuse [2,4,16], most argue usage could be better directed [1,2,11,12,19]. A service audit within a large hospice agency in the United States revealed only 30% of after-hours calls were clinically related, and almost 40% were deemed avoidable [12].…”

Section: Introductionmentioning

confidence: 99%

“…While a few services have reported underuse [2,4,16], most argue usage could be better directed [1,2,11,12,19]. A service audit within a large hospice agency in the United States revealed only 30% of after-hours calls were clinically related, and almost 40% were deemed avoidable [12]. The latter included requests for supplies and medication refills.…”

Section: Introductionmentioning

confidence: 99%

“…Given instances of suboptimal utilisation outlined and considerations of cost effectiveness and service sustainability, rather than focusing on reasons for calls to the helpline [12][13][14]16], exploring dispositions or outcomes thereafter could reveal hidden opportunities for service improvement. Diverse reasons for accessing a helpline may be stratified by urgency, like whether an emergency home visit or hospital admission occurred.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Utilisation of after-hours telephone support in a home-based hospice service

Chong¹,

Lee²,

Yeo³

et al. 2022

BMC Palliat Care

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Background: After-hours support from hospice providers is instrumental to patients with serious illness who choose to remain at home, particularly at end of life. Utilisation of out-of-hours support has been much characterised in terms of frequency and nature of calls, but more needs to be known to inform service customisation and resource allocation to optimise care. To this end, we stratify reasons for using the after-hours helpline according to time sensitivity, and to explore disease and person factors associated with urgent calls.Method: Electronic medical records for incoming calls from external parties outside workhours within a large home hospice in Singapore were analysed inductively, to identify patterns and associations along study objectives. Individual code books for caller type and call reasons were created and tested in vivo, and later administered to extracted data. Patients that accessed the helpline were tracked for different outcomes, including hospital admissions and on-call home visits. Logistic regression modelling was performed to categorise call reasons by urgency and to identify disease and person factors associated with time sensitive calls.Results: More than 5,000 calls to the helpline were made over a two-year period (2019-2020), predominantly by family caregivers (88.4%). These were in relation to 2,303 unique patients (38.9% of total patients served). After-hours calls were made an average of 2.3 times by patients across various lengths of service. Only 11.9% of calls were deemed time sensitive or urgent, requiring home visits by on-call staff (4%) or resulting in admission to hospital (7.9%). The majority were managed by primary care teams on the next workday (65.1%) and the remainder sorted during the after-hours call itself (22.3%). Call reasons or presenting issues were classified into two groups according to urgency. Calls in the year 2020, from the younger patient, preferred place of death outside the home, and caller types other than patient or healthcare worker were significantly associated with urgent calls. Conclusion:Deeper characterisation of after-hours calls offers possibilities: service redesign for optimal resourcing and customised training for better care. Ultimately, planners, providers, and patients all stand to benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Utilisation of after-hours telephone support in a home-based hospice service

Chong¹,

Lee²,

Yeo³

et al. 2022

BMC Palliat Care

View full text Add to dashboard Cite

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A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

Johansson,

Chambers,

Curtis

et al. 2023

Preprint

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Background: People with palliative and end-of-life care needs in the community and their carers often rely on out-of-hours services to remain at home. Policymakers internationally have recommended implementation of telephone advice lines to ensure 24-hour access to support. However, little is known about their effectiveness. Aim: To review the evidence for the clinical and cost effectiveness of out-of-hours- telephone advice lines for adults with palliative care needs living at home and their carers, and report service characteristics associated with effectiveness. Design: Rapid systematic review, with narrative synthesis (PROSPERO ID: CRD42023400370). Data sources: Three databases (Medline, EMBASE, CINAHL) were searched in February 2023 for studies reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Twenty-one studies, published 2000-2022, were included. Most studies were observational; none were experimental. Three were comparative, and seven lacked explicit research questions or methods. Results were largely descriptive, focusing on service development and use, and process measures. Patient and carer outcomes were primarily reported qualitatively. Only two studies investigated possible system outcomes, by examining care-seeking behaviour after using telephone advice lines. Conclusion: Existing evidence for the effectiveness of telephone advice lines is limited. The lack of experimental studies evaluating individual or system-level outcomes prevents assessment of the effectiveness/cost-effectiveness of service models. There is a clear need for more rigorous evaluations using consistent reporting, and inclusion of patient and carer perspectives during both development and implementation. Recommendations for future evaluations are provided.

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Telephone advice lines available out-of-hours to people with palliative and end-of-life care needs: a qualitative interview study with professionals and development of a practical framework to improve services

Pask,

Omoruyi,

Mohamed

et al. 2023

Preprint

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Background People living at home with advanced illness require around-the-clock care. Telephone-based advice lines are critical for accessing help, yet evidence is limited. Aim To explore out-of-hours telephone-based advice lines available to adults living at home with advanced illness and their carers across the UK, and construct a practical framework to improve services. Design Structured qualitative interviews with thematic analysis. A patient and public involvement workshop was conducted to refine the proposed framework. Setting/participants Professionals with palliative/end-of-life care commissioning responsibilities, or knowledge of out-of-hours service provision, were purposively sampled to ensure UK-wide representation. Results Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten models of advice lines were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from simply signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access and information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations. Conclusions Multiple advice lines lead to confusion and delays in obtaining care, as many default to general out-of-hours advice lines. Dedicated advice lines are valuable for patients with advanced illness as long as they are implemented well. A practical framework (including a comprehensive overview of components) is provided for guiding how these are delivered.

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Examination and Analysis of After-Hours Calls in Hospice

Cited by 7 publications

References 13 publications

Utilisation of after-hours telephone support in a home-based hospice service

Utilisation of after-hours telephone support in a home-based hospice service

A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

Telephone advice lines available out-of-hours to people with palliative and end-of-life care needs: a qualitative interview study with professionals and development of a practical framework to improve services

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