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Using a validated case mix tool for use in the telephone-assisted triage of patients in a specialist palliative care community setting: a consecutive case series
  1. Emer Hough,
  2. Michael Lucey,
  3. Martina O'Reilly,
  4. Hannah Featherstone,
  5. Feargal Twomey and
  6. Siobhan Coffey
  1. Department of Palliative Medicine, Milford Care Centre, Limerick, Ireland
  1. Correspondence to Dr Hannah Featherstone, Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland; featherh{at}


Objectives Allocating resources in palliative care is challenging due to the nature of life-limiting illness coupled with the propensity for significant physical symptoms and psychological distress. At present, there is no established system for triaging referrals and prioritising resource allocation.

This study aimed to evaluate the feasibility of using a case mix assessment tool for telephone-assisted triaging of referrals to a specialist palliative care service. This assessed a patient’s phase of illness, Problem Severity Score (PSS) for complexity of symptom burden and psychological distress, and functional status.

Methods Using a prospective consecutive case series approach, 450 referrals to community palliative care over a 6-month period were assessed. Scores for phase of illness, PSS and functional status were assessed at triage, as was the triage category of urgency of response.

Results Analysis demonstrated that phase of illness corresponds with triage category, with terminal or unstable phase patients significantly associated with urgent (category 1) referrals and highest priority for review. Decreased functional status and high PSS were useful predictors for increased urgency of referral.

Conclusions These results demonstrate that this case mix tool could assist in the telephone assessment and triage of referrals to community palliative care.

  • Clinical decisions
  • Home care
  • Supportive care

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  • Contributors EH: Investigation, formal analysis, writing—original draft. ML: Conceptualisation, methodology, formal analysis, writing—original draft, supervision. MO'R: Conceptualisation, methodology, formal analysis, writing—original draft. HJF: Writing—original draft. FT: Conceptualisation, methodology, supervision. SC: Investigation, methodology.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.