Background HCA Hospice (HCA) is Singapore’s largest home hospice care provider, serving 3,600 patients annually. Patients with life-limiting illnesses with an estimated prognosis of less than a year are either seen in a day-care center, or visited at home at regular intervals by nurses, doctors, medical social workers and allied health workers.

The nurses are contactable by external stakeholders such as family members or other healthcare workers by phone during office hours on weekdays from 8.30am to 5.30pm. Phone calls after office hours are received by a call team of a nurse and doctor. The daily duties of a palliative home care nurse during office hours include calling patients to check symptom control, scheduling their visits and multi-disciplinary meetings. During home visits, they take history from the patient and family, perform physical examinations, perform procedures like the changing of feeding tubes and hold conversations with patients and other stakeholders.

Incoming calls during office hours were postulated to cause interruption and disruption to their work, leading to distraction, inefficiency, burnout and staff attrition. A team of four nurses and one doctor were assigned to be first responders to incoming phone calls to the home care nurses. This team receives phone calls that were diverted from the nurses. Phone calls from 30 home care nurses were diverted to the triage nurse team during office hours. The team was equipped with the necessary skills and knowledge to assess and address patient needs over the phone. Call diversion protocols were established to ensure timely and appropriate routing of calls to the triage team. If clinically warranted, the team would make video consultations or make home visits to the patient to manage the patients. Prior to this survey, the effectiveness of this system and its impact on the home care nurses was not studied.

Method Call logs and case notes between Nov 2023 – Apr 2024 are analysed to describe the frequency of calls and the outcomes following MediHELP support. Nursing staff were surveyed about their experience of work having diverted their calls. Qualitative and quantitative data are integrated to produce findings.

Results Preliminary data analysis found a reduction in the number of interruptions and stress experienced by home care nurses following the rapid response team’s implementation. It remains to be seen if this system allows home care nurses to allocate more time and attention to direct patient care.

Conclusion The introduction of a rapid response team in a palliative home care service was effective in reducing interruptions and stress in the schedules of home care nurses. Further research is warranted to evaluate the long-term impact of this medical innovation on patient outcomes and nurse satisfaction.