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Innovative Urgent Care for the Palliative Patient at Home

Montgomery, Carmel L. MN, RN; Pooler, Charlotte PhD, RN; Arsenault, Julia E. MAHSR, NP; Berean, Colleen MHS, RN; Sharman, Robert MA, RN, ACP; Cameron, Cheryl L MEd, ACP; de Kock, Ingrid DA, MBChB

doi: 10.1097/NHH.0000000000000526
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Palliative and end-of-life patients in their homes are at risk of developing symptom crises requiring urgent care. The usual care for these patients involves transport to an Emergency Department (ED) despite the preference of most palliative patients to stay home. The objective of this initiative was to develop an innovative strategy to provide collaborative care in the home to alleviate symptoms and avoid transport. A partnership was created among Emergency Medical Services and Community Care staff, physicians, and leaders to enable patients to stay at home with existing resources during symptom crisis. As a result of the initiative, patients were able to stay at home more frequently. When patients required transport to the ED, it occurred after attempted symptom management in the home. A total of 110 calls were tracked in the first 18 months of the initiative. Of those, 61% ended with the patient staying home, in alignment with their preferred place of care at the end of life. A collaborative approach by care providers in the community enabled patients to stay home despite symptom crisis near the end of life.

Carmel L. Montgomery, MN, RN, is a Clinical Nurse Specialist, Edmonton Zone Palliative Home Care, Alberta Health Services, Edmonton, Alberta, Canada.

Charlotte Pooler, PhD, RN, is a Clinician Scientist, Edmonton Zone Palliative & End of Life and Community Care Programs, Alberta Health Services and Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Julia E. Arsenault, MAHSR, NP, is a Nurse Practitioner, Edmonton Zone Supportive Living, Alberta Health Services, Edmonton, Alberta, Canada.

Colleen Berean, MHS, RN, is a Program Manager, Edmonton Zone Home Care, Alberta Health Services, Edmonton, Alberta, Canada.

Robert Sharman, MA, RN, ACP, is a Program Manager, Edmonton Zone EMS Community Care Program, Alberta Health Services, Edmonton, Alberta, Canada.

Cheryl L. Cameron, MEd, ACP, is a Senior Quality Assurance Strategist, EMS Palliative and End of Life Care, Alberta Health Services, Edmonton, Alberta, Canada.

Ingrid de Kock, DA, MBChB, is a Palliative Care Physician, Edmonton Zone Palliative Care Program, Alberta Health Services and Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.

The authors would like to acknowledge that Carmel Montgomery had full access to all of the data in this initiative and takes full responsibility for integrity of the data and the accuracy of the data analysis. The authors also wish to thank Graeme McAlister, Emergency Medical Services, and Carol Anderson, Continuing Care, for their review of the manuscript.

No potential conflicts of interest, including relevant financial interests, activities, relationships, or affiliations have been declared by any of the authors.

Address for correspondence: Carmel L. Montgomery, MN, RN, 2-124 Clinical Sciences Building, 8440-112 ST NW, Edmonton, AB T6G2B7, Canada (Carmel.Montgomery@ahs.ca).

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