Background Palliative care patients undergoing transitions between hospital and home settings encounter significant challenges. The Rapid Palliative Care In reach Division (RAPID) program was implemented to facilitate this transition during the COVID-19 pandemic. This study examines the utilisation of telehealth modalities and their associations with consultation interventions within the RAPID program.

Methods A retrospective clinical audit was conducted using electronic medical record data from patients seen by the RAPID palliative care service at Monash Health between October 2020 and March 2022. Data included patient demographics, Palliative Care Outcomes Collaboration (PCOC) phase, consultation modalities, and interventions initiated. Descriptive statistics were employed to summarise the demographic characteristics and statistical analysis included t-tests, chi square/Fisher tests, and Mann Whitney U tests where appropriate.

Results This study included 206 patients who collectively participated in 722 consultations, with 76.2% conducted via telephone, 18.6% via video, and 5.2% in person. Among them, 128 patients were from the Community cohort, involving 426 consultations, while 78 patients were part of the Hospital in the Home (HITH) cohort, with 296 consultations. Patients admitted to HITH exhibited prolonged lengths of stay and a heightened frequency of interventions compared to those discharged to community services. Notably, patients of non-English speaking backgrounds (NESB) exhibited a higher incidence for receiving video and in person consultations. The mean age of patients for video and telephone consultations was 69.4 years, while for in person reviews, it was younger at 64.1 years (p=0.028). Comparing video to telephone consultations revealed that video consultations were significantly more likely to involve the commencement or escalation of medications (41% vs 23%, p<0.001), alteration of management plans (26% vs 8%, p<0.001), provision of advice or education (28.4% vs 18.6%, p=0.042), and referrals to other healthcare providers (30% vs 17%, p<0.001). Subgroup analysis based on patients‘ PCOC phase at the time of consultation demonstrated significant differences in medication increases and altered plans for both the Stable and Deteriorating phases. Additionally, more referrals to other healthcare providers via video consultations were observed in the Stable phase compared to telephone consultations. However, no disparities in intervention frequency between modalities were noted in the Unstable and Terminal phases. Furthermore, the involvement of the RAPID program facilitated direct admissions to inpatient palliative care units for 10 patients and direct readmissions to medical units for 14 patients, thereby circumventing Emergency Department presentations.

Conclusion The RAPID program demonstrates the importance of specialised palliative care services in transitional care. While telephone consultations predominated, video consultations were associated with higher intervention frequencies, especially for patients in the Stable and Deteriorating phases. Incorporating video components may enhance intervention rates however further research is needed to validate these findings and explore their impact on patient-specific outcomes, thereby optimising telehealth services in palliative care.