Background There is evidence that using telephone triage to enable access to specialist palliative care services can enhance the assessment of patient need, provide rapid access to specialist services and manage increasing demand (Sutherland & Stananought, 2011).
Audit of patient referrals to our Community Palliative Care Specialist Nurse Service highlighted variability in patient waiting times before accessing the service. We introduced a CNS telephone triage service in June 2017 and are currently evaluating its impact.
Aims To evaluate the extent to which the telephone triage service provides a co-ordinated, timely and responsive service for patients with complex palliative and end-of-life care needs.
Methods Phase 1 Feb-March 2018: Literature review, logic model development. Phase 2 Apr-Sept 2018: Interviews (n=11) and focus groups (n=2) with key stakeholders. Phase 3 Oct-Jan 2019: Online survey with referrers to the service. Phase 4 Mar-June 2019: Case mix analysis of patients allocated Red (Unstable) Amber (Deteriorating) Green (Stable) status at triage; followed for 4 weeks (n=120). We counted: time to first visit, number of visits, telephone calls, OACC measures (Witt, de Wolf-Linder, Dawkins, Daveson et al., 2013).
Results Waiting time from referral to triage to start of CNSs’ care has reduced (2.5 days to 1.4 days average). Patients identified as Red (Unstable) visited within 24/48 hours. Key stakeholders consider that triage has contributed to the delivery of a more timely and responsive service for patients. Referrers commented that the referral template duplicated data on SystmOne. Early case mix analysis indicates minimal differences between the number of visits per patients identified as Urgent (Red) or Deteriorating (Amber).
Conclusion Our evaluation findings demonstrate that telephone triage improves patient access to our Community Palliative Care Specialist Nurse Service. We learnt that the model of triage has to be robust and flexible to withstand unforeseen workforce issues; we are currently exploring alternative approaches.
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