Background Marie Curie is committed to designing and delivering services providing the best possible care and support to people living with any terminal illness, and those close to them. In 2022 it was identified that the system of patient care allocation for overnight visits was not effectively or consistently identifying those with the greatest care needs or fairly allocating care. A working group was set up to address this, taking a QI approach, as no such tool was readily available (Déry, Ruiz, Routhier, et al. Syst Rev. 2020;9(1):227).

Aim To develop a tool that allowed consistent evidence-based assessment of need to determine which patients should be prioritized for care, reflecting different elements that contribute to the requirement for care. The tool needed to be sensitive to stratify patients into 4 categories, P1 through 4 and provide internal consistency when used by different staff.

Method The tool was iterated ten times over 12 months to reflect language, sensitivity, internal consistency and content validity. The tool was then tested in two further areas, and an evaluation confirmed that staff felt it was fit for purpose. It has been incorporated into the electronic patient record.

Results Content included: evidence of confusion/agitation, emotional distress, care needs and symptom control, falls risk, social circumstances and family distress, and predicted impact of care. Each domain scored between 0 and 3, generating an overall score. The tool matched staff’s clinical intuition and standardised the allocation of care. An unintended consequence was prioritizing complex, unstable patients who were not necessarily imminently dying.

Conclusion Staff reported being confident that care allocation was more robust and is more impactful. We are now considering whether we could include volunteers to support those dying well, but whose family needed respite. The tool also informs commissioner discussions.