It is evident that the cohort of patients who have a Life Limiting Illness (LLI) both globally, and in Australia, is significant.^1–4 It should go without saying that as our population’s average age slowly rises, so too does this group of patients whose medical needs and chronic conditions begin to mount. With such a significant collection of patients suffering with a Life-Limiting Illness, it is integral that our healthcare systems are aware of the best practise for how to manage such patients. Multiple rigorous studies have shown that the best practise for a patient with an LLI is a style of care that incorporates a palliative approach.^5–9 This has proven to improve patients’ quality of care and decrease cost of hospital stay per patient.^{5 8} These two metrics of quality of care and clinical cost per patient have emerged as key areas of interest in this field of study.

There is proof that tertiary centres around the globe and particularly in Australia are under-identifying these patients with an LLI, and therefore, there is a proportion of LLI patients being treated as patients without an LLI.^{2 10 11} This under-recognition is leading to poor symptom management for such patients, and potentially unnecessary medical intervention in patients whose goals of care are poorly or not defined at all.

Accurately recognising patients with an LLI and treating them with more of a palliative focus not only increases patient satisfaction, it also leads to a reduction in overall cost per patient. This highlights a significant saving that could be made if tertiary care centres made a more concerted effort to appropriately identify and subsequently modify treatment for patients with LLI’s.

This project will focus on recommendations for a tertiary centre and broader healthcare system to implement, such that we can better identify patients with an LLI. The goal being that if we can more accurately identify these patients, then we can make a positive impact on both patient satisfaction, and cost per patient.

Results Accurately recognising patients with an LLI and treating them with more of a palliative focus not only increases patient satisfaction, it also leads to a reduction in overall cost per patient. This highlights a significant saving that could be made if tertiary care centres made a more concerted effort to appropriately identify and subsequently modify treatment for patients with LLI’s.

Discussion This project recommends the P-CaRES screening tool to be trialled and subsequently introduced to the emergency departments of tertiary centres within Australia. This tool looks to improve recognition of LLI patients by intercepting them at a common point of entry into the Hospital, with a goal of addressing and improving patient satisfaction, and additionally, decreasing overall cost per patient.

References

1. Peereboom K, Coyle N. Facilitating goals-of-care discussions for patients with life-limiting disease—communication strategies for nurses. Journal of Hospice & Palliative Nursing 2012;14(4):251–8.

2. Orford NR, Milnes SL, Lambert N, Berkeley L, Lane SE, Simpson N, et al. Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary icu. Critical care and resuscitation. 2016;18(3):181–8.

3. Gawande A. Quantity and quality of life: duties of care in life-limiting illness. JAMA. 2016;315(3):267–9.

4. Reid EA, Gudina EK, Ayers N, Tigineh W, Azmera YM. Caring for life-limiting illness in Ethiopia: a mixed-methods assessment of outpatient palliative care needs. Journal of Palliative Medicine 2018;21(5):622–30.

5. Aspinal F, Addington-Hall J, Hughes R, Higginson IJ. Using satisfaction to measure the quality of palliative care: a review of the literature. Journal of Advanced Nursing 2003;42(4):324–39.

6. Strasser F, Sweeney C, Willey J, Benisch-Tolley S, Palmer JL, Bruera E. Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: a retrospective descriptive study. Journal of Pain and Symptom Management 2004;27(6):481–91.

7. Back AL, Li Y–F, Sales AE. Impact of palliative care case management on resource use by patients dying of cancer at a veterans affairs medical center. Journal of Palliative Medicine 2005;8(1):26–35.

8. Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. Journal of the American Geriatrics Society 2007;55(7):993–1000.

9. Gade G, Venohr I, Conner D, McGrady K, Beane J, Richardson RH, et al. Impact of an inpatient palliative care team: a randomized controlled trial. Journal of Palliative Medicine. 2008;11(2):180–90.

10. Bowman J, George N, Barrett N, Anderson K, Dove-Maguire K, Baird J. Acceptability and reliability of a novel palliative care screening tool among emergency department providers. Academic Emergency Medicine 2016;23(6):694–702.

11. Milnes S, Orford NR, Berkeley L, Lambert N, Simpson N, Elderkin T, et al. A prospective observational study of prevalence and outcomes of patients with gold standard framework criteria in a tertiary regional Australian Hospital. BMJ Supportive & Palliative Care 2019;9(1):92–9.