The North London Hospice is an 18-bedded hospice in North London, also providing community specialist palliative care to three local boroughs. Patients are admitted either for management of complex needs or for care in the last days of life, with an average length of stay of approximately two weeks.
The RUN-PC triage tool was developed in Melbourne, Australia and published in 2019 (Russell, Philip, Wawryk, et al., 2021. Palliat Med. 35:759). It was originally implemented at the North London Hospice in 2020 following staff and service user feedback expressing dissatisfaction with the length of time between referral and admission, particularly when patients did not achieve their preferred place of death.
Use of the tool was reviewed in 2021 as part of ongoing quality improvement work. Initially a period of observation was undertaken in order to first describe the current triage process, then to identify opportunities for improvement. Baseline data included; average waiting time, compliance with recommended response times as per the RUN-PC manual, and inter-rater reliability. The main areas identified for potential improvement were; frequent absence of a RUN-PC score when patients were initially prioritised at the daily bed meeting, lack of application of the recommended response times, and variation between scorers.
Interventions to date have included using the recommended response time to establish the order in which patients should be admitted, and the development of additional scoring guidance to reduce variability and minimise the impact of pressure from referrers, patients, and family members. Currently referrer satisfaction has improved with evidence of a reduced average waiting time. Efficiency of bed meetings has also improved with more reliable scoring providing confidence in the triage process.
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