Background Referrals to the Coventry Community Palliative Care Team have increased over the last year, with a perceived increase in complexity. This has led to a waiting list and an increase in time to first contact for non-urgent referrals. The team instituted a quality improvement project to see if the responsiveness of the service could be improved, within the constraints of existing resources.
Methods PDSA (Plan, Do, Study, Act) methodology was used. A baseline review of all CNS referrals in December 2017 was conducted. A telephone triage tool and CNS triage rota were developed, along with a telephone triage caseload. A telephone call was made to the patient by an experienced CNS to allow a more robust and consistent assessment of the appropriateness and urgency of the referral. CNS referrals were analysed again in March 2018.
Results The new triage process improved efficiency. The existing process took up to nine days, with up to five documented contacts mainly from district nurses. In March 2018 84% triage was performed with one contact; 26% patient, 36% relative, 10% nursing home staff, 21% other professionals. Only 47% patients triaged needed a face-to-face assessment, all of which were home visits. Non-urgent referrals previously waited up to 20 days to be seen. In March 2018 all referrals were seen within 10 days, with one exception seen at 15 days. All urgent referrals were seen within two days in both December 2017 and March 2018. The triage contact allowed the most appropriate multidisciplinary team member to see the patient.
Discussion A review in working practices has ensured patients are seen by the right professional in a timely manner, improving patient care. The new triage process has improved consistency and provides a more useful assessment of appropriateness and urgency, allowing care to be prioritised.
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