People with a life-limiting illness can have complex needs and may receive care from different health professionals and services. Managing and attending appointments in different settings of care and with different care providers may be difficult for the person, their family and carers, and care may seem disjointed.
Having clear care processes is helpful. This can include who has responsibility for:
When palliative care patients are treated in an emergency, they may be at risk of receiving inappropriate or unwanted treatment. This risk may be reduced through planning.
The ACSQHC comprehensive care standard for end-of-life care (1.87MB pdf) includes teamwork and coordination of care as essential elements. Care coordination in support of this requires:
Practice managers can help by ensuring that GPs provide a letter on the practice letterhead to convey a person’s resuscitation status and treatment preferences.
Download Letter Template Example from Hammond Care (19kb docx)
Download Letter Template Example from Hammond Care
The following documents can help with coordination to improve the quality and safety of care, and reduce unnecessary interventions:
This information was drawn from the following resources:
Watch - When to refer for specialist palliative care and/or end of life care
Use the palliAGED Case Conference forms
Access more Care Coordination Resources
Page created 15 August 2022