Background Many Australians report a preference for end-of-life care at home however, due to both individual and system barriers, often only a small proportion can safely do so.¹ The RAPID Assist program² was established in 2016 to meet the urgent palliative care needs of community patients by facilitating timely support in the home environment. The model consists of a multidisciplinary outreach service, covering a 30km radius of the health services precinct in Parkville Victoria, providing acute specialist palliative care.

Objectives To evaluate the efficacy of the RAPID Assist program in providing timely, coordinated care to support people to die at home.

Methods The RAPID Assist program operates during business hours, delivering care via home visits (residential aged care facilities (RACF) and private residences), telehealth and in-hospital consults. The team comprises clinical nurse consultants, an occupational therapist, and palliative medicine specialists. Collaborative partnerships with Hospital in the Home (HITH), Residential InReach (RIR) and Community Palliative Care services (CPCS) enhance coordination and continuity of care. Data was collected prospectively for patients referred to RAPID Assist between March 2021 and March 2024. Cohort demographics, referral sources/reasons, nature of interventions, community service linkage and outcomes are reported descriptively.

Results During the study period, 988 people were referred to the RAPID Assist program with 804 referrals accepted and reviewed by the service. The main referral sources were HITH and RIR (53.5%) with a large proportion for residents in aged care facilities (66.8%). The primary cause of deterioration on referral was predominantly due to non-malignant causes (60.5%). The primary indications for referral were symptom management (38.5%) and admission to CPCS (29.5%). Most referrals (61.8%) received a same day review, delivered mainly via face-to-face consultation (61.9%) providing multifaceted interventions, and with an average of 1.4 contacts per referral. Most people (78%) indicated a preference to die at home, either in their RACF (61.7%) or private residence (16.3%), and of the 723 who are known to have died during the study period, 77.0% died in their preferred location. Service demographics and outcomes are provided in Table 1.

Discussion The results support RAPID Assist as an effective service model enabling more people living with advanced illness with complex and urgent palliative needs to remain at home. Further research is needed to assess patient and caregiver experience, psychosocial needs, and quality of life.

Conclusion RAPID Assist is an effective service providing timely and coordinated support to optimise hospital-to-home transitions and meet the urgent palliative care needs of patients in the community, to allow more people to die in their place of choice.

References

1. Pinto S, Lopes S, de Sousa A, Delalibera M, Gomes B. Patient and family preferences about place of end-of-life care and death: an Umbrella Review. Journal of Pain and Symptom Management 2024;67(5):e439-e452.

2. Le BH, Marston C, Kerley C, Eastman P. Facilitating the choice of dying at home or in residential care with the implementation of a palliative care rapid response team in a cancer centre and general hospital. Palliat Med. 2019 Apr;33(4):475–476.