Time is precious (T.I.P), a fast track pathway for palliative care patients presenting to the Emergency Department

Mrs Daniela Vasquez1, Miss Lauren Deland2

1Liverpool Hospital, Sydney, Australia, 2Liverpool Hospital, Sydney, Australia

The focus of palliative care is on quality of life through symptom management, utilising a multi-disciplinary approach, whilst providing support to the carer and family. Though not oppositional to the ED process, there are gaps in the approaches to goals of care. Additionally, palliative patients may not be viewed as emergent presentations, resulting in prolonged lengths of stay associated with delays to medical review, initiation of inappropriate investigations or treatments, and delays to initiation of therapeutic medication administration, focussed nursing assessment and appropriate care.

Demand for palliative care services are rapidly increasing, with an increase of 24% of palliative patients presenting to Liverpool ED from 2015 – 2016. Along with a boom in population associated with housing and high residential developments in the LGA, it is expected that demand for services will continue to increase. This pathway aligns with the SWSLHD strategic plan for early identification, assessment and treatment of physical, psychological, socio-cultural and spiritual needs, active support and care, and bereavement services.

The TIP pathway allows for rapid identification of patients who are presenting at end of life, escalated medical review and streamlined care with the multi-disciplinary team to coordinate care based on the patient’s wishes. In built to this pathway is an educational package for medical and nursing staff and a resource pack with a checklist to guide the patient’s journey through the ED to either the ward for ongoing palliative management according to the Care Plan for the Dying Adult Patient, or home (private residence or RACF) with community palliative care or PEACH. The aim of the pathway is to reduce unnecessary delays to patient comfort, staff confidence in managing the patient at end of life, and provision of care to the patient according to their wishes, ‘cause you never get a second chance at dying.


Daniela- i have been working in liverpool hospital for 5 years. I started my nursing in 2007 began as a enrolled nurse working in geriatrics, psycho geriatrics, surgical & cardiology. I then started my new grad program at Liverpool hospital, my 1st rotation in emergency then my 2nd rotation in haemodialysis. I found my home in the ED. I enjoy the thrill the fast paced environment and being there to comfort patients at the weakest moments.

LAUREN- I studied at UOW did my new grad year at st Vincents private 1st rotation head/ neck oncology, plastics 2nd roation gastro/ vascular. Main interest was critical care so did a year rotation of critical care at Sutherland that included 4months ICU, 4 months CCU folowed by 4 months in emergency. This is when i knew emergency is where i wanted to be. I wanted more trauma experience so i made my way to Liverpool.

We lost a father and an uncle who both went through palliative care and this opened our eyes to what was missing. We identified a big gap and we realised that we wanted to make patients comfortable so together we developed the TIP pathway.