The SMART CLINIC
Symptom Management Assessment and Referral Team Clinic – a multi focused approach to a palliative care outpatient clinicPresenters:Dr Adrian Dabscheck –Palliative Medicine Consultant, Western HealthMs Fran Gore – Manager, Mercy Palliative Care Services
Footer Text 2
Our messages:
-Identify the need – know your community
-Persistence – be clear in what you want
-Patience - lots of it!
Footer Text 3
How it all began
Western Health and Mercy Palliative Care share a long standing relationship.
Outreach programme commenced in 2008 resulting in improved patient outcomes.
↑ symptom management
↑ deaths at home
↑ direct admission to inpatient palliative care units
Achieving patient goals of care
Access to hospital pharmacy for non PBS medications
Footer Text 4
How it all began – identifying the need
Both Western Health and Mercy Palliative Care had recognised that a group of patients were ‘slipping’ through the gaps.
Oncology patients seen exclusively as outpatients often had symptom issues that could potentially benefit from palliative care input – either consult service or community palliative care.
These patients are often not referred to palliative care until admitted as an inpatient when disease/symptoms become problematic.
Late referral to community palliative care, or not referred at all and family missing out on bereavement support.
Avoidable presentations to ED or multiple hospital admissions.
Often multiple medication issues
Footer Text 5
How it all began
There was a perception by Cancer Services at Western Health that many of the Oncology patients would gain from earlier Palliative Care in put.
The success of the Outreach program gave Western Health the confidence to build on that and work further to remove the institutional barriers between Hospital and Community care.
Appointment of full time Palliative Medicine Consultant to WH.
Had experience of working in an outpatient palliative care with pharmacy input.
Inclusion of community palliative care would enhance patient outcomes
Footer Text 6
Where to start? – be clear in what you want
Main challenges:
•Funding
•Space
•Bureaucracy
Footer Text 7
Funding
Application for grant funding to Western and Central Melbourne Integrated Cancer Service – successful.
Funding for 12 months:
Project Officer
Clerical and nursing support for outpatient clinic
Pharmacy support for clinic
Need to prove need and sustainability for this period
Only for patient with a malignant diagnosis for the period of the project.
Footer Text 8
Commencement
Recruitment and appointment of Project Officer Feb 2012 – Feb 2013
Review of clinic space in outpatient department – conversion to MBS clinics – more about that later!
Application to WH Ethics committee for approval as a Quality Assurance programme
Project Committee established comprising key stakeholders – internal and external and a consumer representative
Footer Text 9
Background information
Number of unscheduled appointments for palliative care consultants in
Day Oncology – 92 informal palliative medicine consults in 12 month period
Outpatient Department – 74 informal palliative care medicine consults in Gen Oncology in 12 month period
Back ground survey conducted:
What amount of time do medical staff time currently spent on symptom management and end of life issues? – survey of consultants and registrars from all tumour groups.
Could a symptom management clinic with a palliative approach assist with this?
Footer Text 10
Background information
83% response rate from 70 medical staff from tumour streams at Western Health
74% of these were consultant medical staff
26% were Registrars
All were potential referers
Footer Text 11
Background information
:
Results
Footer Text 12
Background information
91% stated they would refer to a clinic set up specifically for symptom control issues
Benefits of such a clinic were rated by the respondents in the following order:
1.Improved symptom management
2.Improved pain control
3.Facilitating community palliative care referral
4.Facilitating discussion of end of life issues and patient goals of care
5.Streamlining specialised care from general ( oncology) clinics
Footer Text 13
Background information
•Supported anecdotal evidence of need
•Survey served as an awareness raising exercise
•All tumour groups supportive of clinic
“How soon can you start!”
• Divisional Director and Manager supportive
Footer Text 14
Commencement
•Project committee and working groups established
• Clinical• Evaluation = sustainability• Pharmacy
Footer Text 15
Footer Text 16
Footer Text 17
Commencement
•First clinic held May 31st - along side colorectal clinic
•Referrals slow at first
•However, benefits apparent from the onset
• Provision of emergency injectable medications• Linking to community palliative care sooner rather than later
• 24 hour number
• Bereavement support
Footer Text 18
Challenges and learnings - patience
•Working within an MBS clinic environment
• Income generation• Medication dispensing
• Clinic space!!!
• Ensuring data collection to prove sustainability
•Data entry – who does
•Software
• Availability of Pharmacy staff – no backfill for leave
• Change of time/day and location of clinic
Footer Text 19
Results to date:Consultations 18 new 6 review
Referral source Colorectal Unit - 4 Lung unit - 4 General Oncology - 5 Emergency Day OncologyRenal Unit BreastOnc. Ward - 1 each
Reason for referral 3 Pain Management 8 Combination Pain and Symptoms4 other symptoms
2 link to community palliative care
1. Regular blood transfusions organisation
Pharmacy input 16 Pharmacy Care Plan commenced
5 provided with injectable medications
16 medication education
1 community pharmacy contact
Pain scores reduced 6 out of 8 ↓ pain scores
Not all able to be followed up
Referrals to community palliative care
12
Deaths 1 – at home
Footer Text 20
Feedback
Patient survey developed based on the UK Picker Institute examining patient and carer experience around the domains of:
Respect for patient centred values
Coordination and integration of care
Information, communication and education
Physical comfort
Emotional support
Welcoming the involvement of family
Transition and continuity
Access to care
Footer Text 21
What do patients say?
•Number of surveys to date: 8
•Themes
• Positive experience of palliative care• Better understanding of medications• Family/carer involvement• Identification of palliative care as part of
treating team
Footer Text 22
Challenges to date• Pharmacy issues related to MBS Model.
• Different model than we planned for as it does not run in parallel with Oncology OP, due to lack of physical space.
• The usual teething problems one would anticipate setting up a new clinic in a very busy public hospital, but there has been an amazing amount of good will to assist clinics establishment.
Footer Text 23
Progressing the SMART Model
• New Symptom Control Clinic at Sunshine Radiotherapy Centre.
• Palliative Medicine works in parallel with Radiation Oncology.• Successful from an Institutional perspective and from patient
perspective as shown by survey results.• Working towards using SMART Clinic model at Sunshine
Radiotherapy Centre.
Footer Text 24
Acknowledgements
•WH Divisional Director – Ms Jenny Walsh
•WH Director of Cancer Services– Prof Michael Green
•WH Cancer Services Manager – Ms Adele Mollo
•WH Director Palliative Care – Dr Maria Coperchini
•Mercy Health
•Project Officer-Kathy Hendry
•WCMICS as project funding body
Top Related