Help Is a Phone Call Away: A 24-Hour Nurse-Led Pediatric Hospice Clinical Care Line

BACKGROUND: Children with life-limiting conditions often have complex care needs, and their caregivers require expert clinical support after-hours and over weekends to support care at home. OBJECTIVES: This quality improvement initiative examined usage patterns and impact on caregiving of the nurse-led 24-Hour Clinical Care Line initiated in 2018 by the Canuck Place Children's Hospice, which provides inpatient and community-based pediatric palliative care and respite for children with life-limiting conditions in British Columbia and the Yukon in Canada. METHODS: Phone call tracking logs and clinical profiles were analyzed to examine user demographics, temporal usage patterns, and reasons for calling. Families were asked to provide feedback on the service for quality improvement. RESULTS: From June 2020 to March 2024, 194 families placed 1106 calls. Mothers/foster mothers made 67% of the calls. Caregivers of children with central nervous system (CNS) and metabolic conditions made a significantly higher number of calls per child on average. Caregivers calling about children aged <1 year represented a disproportionately large group of callers. Parents of children >15 years made significantly fewer calls. The most common call reason was family support (73.1%), followed by providing an update on child status (58.5%), pain and symptom management (50.9%), and care planning (10.9%). Call volume peaked at bedtime and was consistent over nighttime hours and weekends. Late winter and spring were the most popular seasons for calls, following typical temporal influenza patterns.