Case conference resource guide
Albury Wodonga Regional GP Network
This resource guide was developed to assist general practitioners who wish to organise or participate in case conferences for patients with complex needs.
Further information: Shelby-James TM, Butow P, Davison G, Currow DC. Case conferences in palliative care - a substudy of a cluster randomised controlled trial. Aust Fam Physician. 2012 Aug;41(8):608-12.
Ref: Albury Wodonga Regional GP Network. Case conferencing resource guide. Wodonga (VIC); Albury Wodonga Regional GP Network. (197kb pdf)
Ambulance protocol for palliative care NSW – Authorised Adult Palliative Care Plan
Ambulance NSW / Southern NSW Local Health District / Southern NSW Medicare Local
The Authorised Adult Palliative Care Plan was designed in NSW, but similar information would be helpful for ambulance transfers in any state. It defines care choices for a patient in the event of an ambulance call-out, and allows emergency care to be provided by paramedics in the home where appropriate. It can prevent initiation of inapproprate or unwanted resuscitation efforts, and provide contact information for paramedics to request guidance.
Further information: Ambulance plan helps palliative care patients after hours
Ref: Ambulance Service of New South Wales. Authorised Adult Palliative Care Plan: Respecting patient wishes. (660kb pdf)
Model letter - For communicating a patient’s resuscitation status and treatment preferences
HammondCare Palliative Care Service, North Sydney
To whom it may concern (for example emergency staff and ambulance officers) ______________
Re: (Name of patient, address, date of birth) ________________________
(Name of patient) _____________has (type of life limiting condition) ____________. In view of (name of patient)’s overall prognosis, CPR/Intubation/intensive care should not be attempted if his/her condition deteriorated, as this would be highly unlikely to be successful and would be inappropriately burdensome. This has been discussed with (name of patient)___________, and his/her (spouse/other caregiver etc)___________ and 'person responsible' (name of person(s))___________, and they agree that CPR/intubation/intensive care should not be attempted. If (name of patient)________________ were to become critically unwell, s/he would wish to be allowed to die naturally and to have full comfort care. (Name of patient)_____________ has requested that I write this letter to document his/her wishes.
(Name of patient)______________ is receiving palliative chemotherapy, so transfer to an acute care facility may still be appropriate at this stage, for example to administer intravenous antibiotics and fluids, if indicated.
(Name of patient)____________ would prefer to remain at home as long as possible and if feasible to die at home.
(Name of patient)_____________ would prefer to avoid readmission to the acute hospital. If s/he develops symptoms that are not able to be managed at home then s/he could be (re)admitted to (name of palliative care unit or alternative place of care)_________________.
(Name of patient)__________________ and/or their family have discussed these issues with (name of clinician)_____________.
For any further information about this patient please contact (GP and/or palliative care service contact information)_______________________
(Name and designation)___________________
Community Palliative Care Team
Other specialists involved in the patients care
Home Nurses if applicable
PCEHR - Personally controlled electronic health record
Department of Health - Frequently Asked Questions (FAQs)
The PCEHR contains a health summary including a medication list and an event summary (for documentating any significant health event - for instance after hours contacts, or contacts with a non-usual GP, and so on). It also allows patients to document their own personal health notes, and their emergency contacts, and it can be accessed by all treating clinicians.
Ref: Department of Health. Frequently Asked Questions (FAQs) [Internet]. 2014 [updated 2014 Dec 01; cited 2015 Mar 5].
Last updated 16 February 2017