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O-9 Prioritising referrals to a specialist palliative care service
  1. Margaret Clifford,
  2. Carl Stanborough and
  3. Thomas Osborne
  1. St Joseph’s Hospice, London, UK


Introduction With increasing referrals to specialist palliative care (SPC) services at a time of limited resources, effective triage systems are essential. This community SPC service uses a ‘RAG’ triage system, whereby a multidisciplinary team (MDT) decides daily if referrals should be categorised as ‘Red’ (seen within 24 hours), ‘Amber’ (3 days), or ‘Green’ (10 days).

Aims To assess if the MDT correctly prioritises referrals according to palliative care need.

Methods Referrals between 1/1/16 and 12/5/16 were examined retrospectively. Patients were RAG rated at referral. The Integrated Palliative Care Outcome Scale (iPOS) and phase of illness (POI) were recorded at the first visit. Higher iPOS scores, ‘Unstable/deteriorating/dying’ POI or shorter time between first and second contacts were taken as proxies of greater palliative care need, with lower iPOS scores, ‘Stable’ POI or longer time between contacts indicating lower need. One way ANOVA compared RAG to total iPOS scores and time between contacts. Chi-Square tested the association between RAG and POI (‘stable’ versus ‘unstable/deteriorating/dying’).

Results 296 patients received a RAG rating. Of these, 217 had an iPOS and 207 had a POI completed at the first visit. Red patients had a mean iPOS score of 21, Amber 18 and Green 15 (p=0.001). The mean number of days between initial contacts was 3 for Red, 8 for Amber and 11 for Green (p=0.001). There was a significant association between RAG triage category and POI (Chi-Square=36.9, p=0.000). This was in the expected direction with 67% of patients triaged as Green assessed as ‘Stable’ at the first visit, compared with 46% of Ambers and 3% of Reds. 97% of Red patients were ‘unstable/deteriorating/dying’ at first visit, compared with 54% of Ambers and 33% of Greens.

Conclusions These findings support the RAG triage system as a way of prioritising new referrals to a SPC service.

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