Hospice advice and rapid response service for ambulance clinicians

Abstract

ObjectivePatients in the last year of life experience medical emergencies which may lead to an emergency attendance by ambulance clinicians and some patients having a transfer to hospital even when this is unwanted by patients, carers or professionals. Here we report the patient characteristics and outcomes of a 24-hour hospice nursing telephone advice service to support an ambulance service.MethodAn evaluation of the outcomes of ambulance calls to a nursing telephone advice service for people living in northwest London, UK, attended at home during a 6-month period by the London Ambulance Service, whose clinicians then sought advice from the hospice’s 24 hours’ telephone line.ResultsForty-five attendances of 44 acutely ill people with palliative care needs resulted in a telephone call. Thirteen patients (30%) were male and the median age was over 80 years. Thirty-two attendances (71%) were managed without a transfer to hospital, with telephone advice from the hospice and in some cases arrangements for another clinician to visit. Seven attendances (16%) resulted in a transfer to hospital, of which at least five led to an admission. Six attendances (13%) resulted in a notification of the patient’s death.ConclusionsThis preliminary study shows the feasibility, outcomes and acceptability of telephone advice to support ambulance clinicians attending patients with palliative care needs. The service was associated with low rates of subsequent transfer to hospital. Further controlled research is needed to assess the clinical and cost-effectiveness of the service.

Emergency medical services and palliative care: a scoping review

“…Included studies were performed in the USA (n=16),1 6 26–39 the UK (n=9),7 14 40–46 Germany (n=10),8 47–55 Australia (n=8),2 4 11 56–60 Canada (n=4),15 61–63 France (n=1),5 Switzerland (n=1),13 New Zealand (n=2),64 65 Finland (n=2),66 67 Czech Republic (n=1),68 Brazil (n=1)69 and South Africa (n=1)16 between 2002 and 2022. The majority of studies (96%, n=54) were performed in HICs with only Brazil and South Africa representing LMICs, and most (63%, n=35) were published between 2018 and 2022.…”

“…Methodologically, most studies were quantitative (55%, n=31) while the remainder used a qualitative (27%, n=15) or mixed-methods (18%, n=10) approach. Quantitative studies comprised of surveys (n=12),1 8 30 32 38 41 43 48 49 51 56 58 retrospective cohorts (n=9),5 33 34 40 52 54 55 57 66 literature reviews (n=5),11 46 61 64 68 case series/reports (n=3),6 13 35 a pre-intervention and post-intervention study (n=1)29 and a prospective cohort (n=1) 8. Qualitative studies contained individual interviews (n=12),7 14 16 26–28 31 42 44 47 65 69 focus group interviews (n=2)2 63 and deliberative dialogues (n=1),62 while the mixed-methods studies4 15 36 37 39 45 50 59 60 67 made use of various survey and interview combinations.…”

“…59 Simply improving communication between the two systems may confer benefit as demonstrated by Dent et al where palliative telephonic advice provided to EMS resulted in decreased rates of hospital conveyance. 40 Similar integrative approaches have been successfully employed in HICs for mental health emergencies, linking mental healthcare workers with EMS and police to provide consult at point of care. 72 The 1990 Commission on Health Research for Development affirmed that strengthening LMIC research capacity is 'one of the most powerful, cost-effective, and sustainable means of advancing health and development'.…”

Co-designing Community Out-of-hours Palliative Care Services: A systematic literature search and review

“…Telehealth including telephone consultation 8,43,47,48,60,69,70,74,86,90,[102][103][104][105][106][107]109 17 (22.1)…”

“…Specialist Palliative Care Service 47,48,68,69,74,80,86,94,[102][103][104][105][106][107]109,110 16 (20.8) Home visit 44,48,74,77,83,91,92,99,100,[102][103][104][105][106]112 15 (19.5) Triage Service (deliver via telephone or face-toface) 47,71,74,86,[91][92][93][102][103][104][105] 11 (14.3) Domiciliary Service 46,47,68,71,74,86,[91][92][93]…”