Background: Collaboration between palliative care units (PCUs) and community palliative care (CPC) services is key to providing integrated care across inpatient and outpatient settings, in response to local and global challenges.

Aim: To identify the effect of the COVID-19 pandemic and local CPC service changes on the characteristics of patient admissions, discharges, and access to a specialist PCU in Sydney, Australia.

Methods: A retrospective cohort study of PCU admissions was performed across three six-month periods, in 2017, 2019 and 2021. The association between patients’ principal diagnoses and CPC service involvement prior to their first PCU admission was analysed. Admission characteristics including referral source, length of stay, palliative care phase and place of death were compared between the three time periods. 

Results: There were 707 admissions during the studied time periods, corresponding to 589 unique patients, of whom 89% had a principal diagnosis of malignancy. Non-cancer patients had half the odds of being linked to a CPC service compared to cancer patients on admission (OR = 0.48), and haematology patients a third of the odds compared to other patients (OR = 0.34). Most admissions (51%) were arranged to the PCU directly from the community. Compared to earlier time periods, during the COVID-19 pandemic peak in 2021, patients had shorter admissions (5 vs 8 days; p <0.001), were more likely to be discharged in the deteriorating or terminal phases (p <0.001), and had four times the odds of dying at home (OR = 4.11).

Conclusions: COVID-19 has had significant impacts on PCU admissions and patients’ preferred location of care, which has implications for the development of sustainable models of care to meet the increasing demands on CPC services. Continuous service delivery evaluation and adaptation is required to ensure equitable access to palliative care for all patients, especially during periods of change.