Background The provision of high-quality person-centred specialist palliative care requires effective mechanisms to ensure timely input of services. The time between referral and initial review is a marker of efficient service functioning.
The aim of this project was to audit compliance against the local standard that ‘patients referred to the hospital Symptom Control and Palliative Care team should be reviewed within 24hrs unless there is an appropriate documented clinical reason’.
Methods Multi-cycle audit:
Cycle 1: Baseline retrospective audit of referrals 01/04/2020–31/03/2021.
Cycles 2&3: Rolling prospective two-weekly audit of inpatient referrals 22/08/22–25/09/22.
Data were extracted from the electronic patient record, departmental activity database (aligned to the electronic patient record but with separate data entry) and patient handover lists.
Results Cycle 1: Of a total 1909 referrals, information about timing between referral and review was available for 1898. 99% of these patients were reviewed within 24hrs. 18/19 patients reviewed >24hrs had appropriate documented reasons for the delay e.g., planned future assessment. 18 inaccuracies between the electronic patient record and the activity database were reconciled. (missing/incorrect dates).
Prior to cycle 2, the handover list design was updated and team training provided.
Cycles 2&3: 95% and 100% of inpatients referred were reviewed within 24hrs of referral respectively.
Conclusion Adherence to local operational policy ensures timely review for patients referred to the hospital Symptom Control and Palliative Care team and provides one measure of quality of care. Activity monitoring embedded within the electronic clinical record would reduce duplication of data entry and data mismatch. Effective mechanisms to support prompt review will vary depending on the location of the patients (hospital/hospice/community) and could include triage based on individual patient needs. The importance of proactive approaches to ensuring timely review is fundamental considering the increasing volumes of patients requiring specialist palliative care input.
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