Proposed components of the Criteria for Screening and Triaging to Appropriate aLternative care tool to identify end-of-life status after a rapid response call where a do-not-resuscitate order is not in place
| □ | Age ≥6542638586 |
|---|---|
| □ | AND admitted via emergency this hospitalisation96 (associated with 25% mortality within 1 year) |
| □ | OR met 2 or more of the selected MET calling criteria below30 32 98 |
| □ | 1-Decreased LOC: Glasgow Coma Score change >2 or AVPU=P or U |
| □ | 2-Systolic blood pressure <90 mm Hg |
| □ | 3-Respiratory rate <5 or >30 |
| □ | 4-Pulse rate <40 or >140 |
| □ | 5-Need for oxygen therapy or known oxygen saturation <90%33 |
| □ | 6-Hypoglycaemia: BGL99 |
| □ | 7-Repeat or prolonged seizures99 |
| □ | 8-Low urinary output (<15 mL/h or <0.5 mL/kg/h)100 |
| □ | OR MEW or SEWS score >446 79 |
| AND | OTHER RISK FACTORS /PREDICTORS OF SHORT-MEDIUM-TERM DEATH |
| □ | Personal history of active disease (at least one of):18 25 42 46 63 96 101 |
| □ | Advanced malignancy |
| □ | Chronic kidney disease |
| □ | Chronic heart failure, |
| □ | Chronic obstructive pulmonary disease |
| □ | New cerebrovascular disease |
| □ | Myocardial infarction |
| □ | Moderate/severe liver disease |
| □ | Evidence of cognitive impairment (eg, long-term mental disorders, dementia, behavioural alterations or disability from stroke)25 42 63 73 83 96 |
| □ | Length of stay before this RRT call (>5 days predicts 1-year mortality)46 96 |
| □ □ | Previous hospitalisation in past year10 repeat ICU admission at this or previous hospitalisation95 (associated with a fourfold increase in mortality) |
| □ | Evidence of frailty: 2 or more of these: 42 46 63 85 89 98 |
| □ | Unintentional or unexplained weight loss (10 lbs in past year)18 83 85 |
| □ | Self-reported exhaustion (felt that everything was an effort or felt could not get going at least 3 days in the past week)85 |
| □ | Weakness (low grip strength for writing or handling small objects, difficulty or inability to lift heavy objects ≥4.5 kg)63 |
| □ | Slow walking speed (walks 4.5 m in >7 s) |
| □ | Inability for physical activity or new inability to stand46 98 |
| □ | Nursing home resident/in supported accommodation33 46 96 |
| □ | Proteinuria on a spot urine sample: positive marker for chronic kidney disease & predictor of mortality: >30 mg albumin/g creatinine56 103 |
| □ | Abnormal ECG (Atrial fibrillation, tachycardia, any other abnormal rhythm or ≥5 ectopics/min, Changes to Q or ST waves18 42 97 |
MET, medical emergency team; MEW, modified early warning; RRT, rapid response team.