Griffith is a multicultural city in south-western NSW, with a population of 16,972, with a greater population living in the surrounding rural and remote areas. Palliative Care & End of Life [EOL] Services, were being provided by a wide range of service providers, in both acute and community sectors. Despite Strategic Planning and Model of Care directives, variation in the integration of services and a lack of resources meant that patients and carers were subject to variations in methods of service delivery.

2. Annie Williams
MLHD Manager of Innovation & Redesign
Palliative Patient Journeys
Providing Services in a Regional and Rural Setting

4. Palliative Care Service Delivery in MLHD
NSW Health
Palliative Care
Services Plan
NSW Palliative Care
Strategic
Framework
MLHD Palliative Care Clinical Services Plan
How are we
delivering
Palliative Care
Services now?
Western
eastern

5. Primary
Enhanced
Level 1:
Specialist.
MLHD Palliative Care Model

6. Objective:
 To provide a current state business process and patient
journey analysis of the MLHD Palliative Care Patients
whom access services within Griffith and the
surrounding region
Scope:
 Documentation of current palliative patient flow, operational activities and business
processes centred on Griffith, and local communities
 Processes from Patient referral to EOL care

7. 160 KM
65KM
110KM
90
KM
140KM
60
KM
Geographical Implications:

8. Project Methodology:
Patient and Carer Interviews:
De-identified interviews conducted with palliative patients,
and/or carers whom have referred to or accessed the
services of the Palliative Care Service.

9. Process Mapping:

10. Patient Flow - Data Analysis Outreach Sites:

11. PC Team Roster &
Service Model Changes
MLHD: GRIFFITH CH PALLIATIVE CARE SERVICE ACTIVITY
OCCASIONS OF SERVICE – IN HOURS AND AFTER HOURS
Patient Flow - Data Analysis Griffith:

12. Admissions28 %decrease
Patient Flow – Community to Acute Care:

13. MLHD: PALLIATIVE CARE
Multiple Admissions & Readmissions to Griffith Base Hospital
71 %
decreas
e
Patient Flow – Readmissions to Acute Care:

14.  A decrease in the
number of acute
Palliative Care
admissions
 A consistent length of
stay for Palliative Care
patients [median 4 days
from 2012 to 2015]
 A significant drop in
Palliative Care patients
whom are admitted to
the acute service on
more than one
occasion
 Early identification of
patients
 A proactive approach to
resourcing and delivery of
supported palliative care in
patients homes,
 Provision of after hours
services to unstable patients
only as required
 Building of enhanced
relationships with outreach
sites
Patient Flow – Key Findings:

15. Quantification of Patient Experience
Patient and carer perceptions of the healthcare journey comprise the
“Patient Experience”. Research from the NHS & Picker Institute
provides key themes valued by both patients and carers:
Access to Care
Respect for Patient values, preferences, and expressed needs
Coordination and integration of care
Information and education
Transition and continuity
Physical comfort
Emotional support and alleviation of fear and anxiety
Involvement of family and friends

16. What our patients and carers told us:
Early on, it was necessary
for Lois to have a syringe
driver, so that it could help
to manage her pain. This
worked as a partnership
between myself and the
Palliative Care Nurse; we
worked really well
together.
I think that this is a great
idea to investigate how to
do longer term patient
surveys and to talk about
our experiences – it is the
only way that we can
improve the services to our
communities and
acknowledge the great
services we have!
We wish we knew
about it sooner!
… things were
deteriorating; they
were there
whenever we
needed them.
…my GP who I knew very well and
was caring for me well, does not
have admitting rights to the
hospital, so each time I went in,
there was a process of
transferring my case over to
another doctor,
I had only ever heard about Palliative Care in
relation to cancer care, I didn’t realise that
they could support Charley in the end stages
of his illness
I was told by the
nurse to “get
dressed you are
going home”. ..no
one had told me
of any plans

17. Palliative Patient Journey – Acute Palliative Care Services
Palliative Patient Journey–Community Palliative Care Services
Quantification of Patient Experience

18. Patient Journey Impacts
GPPCT
HOM
E
AH
ED
ACUTE
D/C