Background/Aims One third of inpatients are in their final year of life and are challenging to identify leading to development of trigger tools to aid clinician recognition. The National Institute of Clinical Excellence highlight the requirement to include a trigger tool in end of life service delivery. Using data from a previous audit we developed a novel trigger tool - Pallitrigger.
Methods Retrospective audit of 30 randomised inpatients on the acute medical unit during January 2020 were reviewed against the Pallitrigger tool. Parameters included age, disease progression, deteriorating performance status, number of admissions in the previous 3 months, death within 12 months, symptom severity and red flag signs/symptoms. The presence/absence of a co-ordinate my care records, palliative care referral and length of stay were also reviewed. All data was anonymised and analysed using Excel.
Results The mean age was 68 years (43y – 94y). Total number of females were 13/30 and males 17/30. Length of stay ranged from 1 day to 67 days. Pallitrigger was positive for 63%, with 68.4% (13/19) of these identified patients dying within 12 months. 31.6% patients did not die within 12months however satisfied 1 or more of the triggers. 36.6% (11/19) patients had admissions in the preceding 3 months and with 64% (7/11) of these patients dying within 12 months.
Conclusions Using the Pallitrigger tool we were able to capture 68% of patients who were in the last year of life. This was an increase of 22% compared to the Supportive and Palliative Care Indicator Tool audit (46%). The most common trigger (11/30) was previous unplanned admissions within the preceding 3 months followed by severe symptoms (10/30).
The tool improved identification of patients with potential unmet palliative care needs compared to clinician identification. Only 10% of patients were identified by clinicians versus 68% of patients screened with Pallitrigger.
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