Improving triage in palliative care

According to St Vincent’s Palliative Medicine Consultant Dr Beth Russell, triage in palliative care can be a real clinical problem.

‘If you have only got one bed left on the palliative care ward, or if you have got time to do only one home visit for the day, but you have got lots of referrals, who should you see first?’ Beth asks.

‘Should you see the person who is imminently dying with a stroke?  Should you see the person who has cancer with out of control pain?  Should you see the person who is deteriorating with heart failure at home and not able to walk to the bathroom anymore?  Or should you see the person who has high care needs and their carer is just having absolute meltdown and is burning out?’

Dr Beth Russell
Dr Beth Russell

Currently, there is no systematic way of comparing one palliative care patient’s needs against another anywhere in the world, but that’s about to change. Dr Russell has spent the last three years developing a world-leading palliative care decision-making tool.

‘The tool will ensure that we are transparent, equitable, and that we are making every effort to make sure that the person who has the most urgent needs gets seen first,’ Dr Russell says.

The research was done with a qualitative study involving focus groups and interviews with palliative care providers, clinicians, bereaved carers and consumer representatives. From that, the team worked out seven factors that are important when assessing the urgency of patient needs.

Over 800 clinicians from all over the world also participated in an online experiment, which Dr Russell says reflects how important clinicians consider the issue of triage to be. The results from the study led to complex statistical analysis and helped to generate a scoring system.

Doctors now have a tool that easily gives each patient a score which can be compared with another patient to determine the urgency of their need.

‘We think it will change palliative care practice across Australia and worldwide,’ Dr Russell says. ‘Facilitating equitable access to care is in line with St Vincent’s Mission and we’re very confident that this will improve access to palliative care for all people depending on their need.’

The tool is set to be implemented in the new year.

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