Breaking down the silos: Collaboration delivering an efficient and effective response to palliative care emergencies

Objectives: The objective of this article is to explore the introduction of a rapid response team as outlined in the South Australian Palliative Care Services Plan 2009-2016. The Plan identifies this service as being provided by nurse practitioners. This workforce is not yet fully developed so a partnership model utilizing the extended care paramedic has been explored for the provision of out-of-hours emergency care to palliative patients. Methods: A working group was established under the auspices of the Palliative Care Clinical Network to progress the partnership model of care. Key stakeholders from SA Ambulance, the Royal District Nursing Society, Flinders University, and Specialist Palliative Care Services (SPCS) made up the steering committee. Satisfaction telephone surveys were conducted following the trial phase to assess the community acceptance of this model. Results: Data were collected from across the metropolitan area of Adelaide. There were 40 paramedic visits during the 118 days of the trial, which equates to 10 days per month. About 78.5% of the patients requiring this service were registered with a SPCS. Satisfaction from patients, caregivers, and the extended care paramedics was high. Conclusions: This partnership model has enabled an emergency after-hours service to be provided between the SPCS and the ambulance service. This unlikely alliance has been very well received by patients and family members wishing to remain at home. Early data reveals that 90% of unnecessary and unwanted admissions to hospitals have been avoided in the palliative care population.