MAPping our own course: The journey of the Milford Ambulatory Palliative Care (MAP) Clinic

Why did you do it? The Milford Ambulatory Palliative Care (MAP) clinic was established to support and enhance clinical and service efficiency within the existing community palliative care (PC) service. This aims to address the rapidly growing demand for community PC and enhance integration between acute and community services. Who is it for? Our community palliative care team (CPCT) caters for a 408,000 population in three counties in Ireland. This is provided across 8,000 square kilometers representing a significant logistical challenge in providing timely care. The MAP clinic supports the CPCT by providing expedited access to the multidisciplinary team (MDT) for timely delivery of patient care. Who are you involving? CPCT triage nurses. Department managers. PC consultant, PC nurse specialist, physiotherapist, occupational therapist, and social work. Patients/caregivers attending the clinic are equal partners; they engage in feedback to guide service development. What did you do? The MAP clinic is a weekly MDT clinic established in January 2023 utilising existing MDT frameworks within the organisation. Referrals to the clinic are triaged from existing CPCT referrals. Referral criteria include (i)Resource Utilisation Groups-Activities of Daily Living (RUG-ADL) of ≤12 (ii)Australia-modified Karnofsky Performance Status (AKPS) ≥50 (iii)Access to transport (iv)Willingness to travel to the clinic. Once identified, a pre-MAP clinic MDT meeting occurs to ensure patients see the relevant MDT disciplines. This clinic allows the MDT to perform a comprehensive initial assessment and develop and enhance care plans for PC patients who would otherwise be seen over an extended period in their homes. The clinic alternates between nurse and consultant-led on a weekly basis with one-hour slots allocated per discipline. Once completed, an MDT meeting is held to discuss patient follow-up in the most appropriate setting for their needs. What impact did you have? 57 patients were reviewed over ten-months; 37 had malignant and 20 had non-malignant diagnoses. 24 were seen by a PC consultant, 33 by nursing staff, 49 by physiotherapy, 34 by occupational therapy and 29 by social work. Post-MAP follow-up included referrals to PC day unit (n=25), CPCT (n=17), medical outpatients (n=9), physiotherapy outpatient (n=1), discharged (n=5). Thus far, the MAP clinic has saved 9021 kilometres and 152-hours of staff travel time equating to €6700 saved on staff wages for travel time alone. €7217 saved on associated transport costs. Preliminary patient evaluation revealed 100% (n=13) of patients found the clinic beneficial. Preliminary staff evaluation (n=7) showed the MDT find the clinic beneficial for patients (100%), helps streamline patient follow-up (100%) and saves time and resources (100%). What is the learning for the international audience? This pilot ambulatory PC clinic augments care through timely and comprehensive initial reviews on-site by an MDT. This provides significant savings on staff time and resource expenditure, while enhancing patient access to the MDT service, care, and satisfaction. What are the next steps? Ongoing evaluation of staff and patient feedback to guide quality improvement projects. Opening further MAP clinics across the community with applications to resource these. We are piloting one such clinic currently with encouraging results.