Paediatric palliative care medical hotline: retrospective database study.

Abstract

Background: Clinical emergencies may occur at any time in paediatric palliative care (PPC). Our PPC team offers an on-call 24 hours a day, 7 days a week medical hotline assistance (MHLA). We report the experience of our MHLA during 2021, focusing on phone calls registered out of working hours.

Methods: Patients/families followed up by our team and who used the MHLA during 2021 were considered. The aims were to characterise the use of MHLA and to describe the immediate patient's pathway.

Results: 232 children/families were followed. Half had disabilities or multiple disabilities. Though each patient benefited from advanced care planning, medical advice requests to/from families (N=864) were registered out of working hours in 160 (19%) cases. They concerned 31 different patients. Incoming calls were made by parents (n=130: 81%), or caregivers (n=19: 12%), while our team called a hospital team (n=11: 7%) to either announce and discuss hospitalisation (n=9) or discuss medical plan while the child stayed at home (n=2). Most calls dealt with a combination of symptom management (n=150), coordination of care (n=9), psychological support (n=3) and/or coordination of the home-hospital trajectory (n=11). 76 (47%) were classified as emergencies: 55/76 concerned clinical situations deemed 'biomedical emergencies' (need for therapeutic adaptation), while 21/76 were solved by reassurance. Only 9/76 (12%) were transferred to the hospital unit.

Conclusion: Day and night medical advice requests managed by our PPC team out of working hours helped to avoid admission to the emergency unit in 88% of overall emergency calls received.