Table 4

Proposed components of the Criteria for Screening and Triaging to Appropriate aLternative care tool to identify end-of-life status after a rapid response call where a do-not-resuscitate order is not in place

Age ≥6542638586
AND admitted via emergency this hospitalisation96 (associated with 25% mortality within 1 year)
OR met 2 or more of the selected MET calling criteria below30 32 98
1-Decreased LOC: Glasgow Coma Score change >2 or AVPU=P or U
2-Systolic blood pressure <90 mm Hg
3-Respiratory rate <5 or >30
4-Pulse rate <40 or >140
5-Need for oxygen therapy or known oxygen saturation <90%33
6-Hypoglycaemia: BGL99
7-Repeat or prolonged seizures99
8-Low urinary output (<15 mL/h or <0.5 mL/kg/h)100
OR MEW or SEWS score >446 79
Personal history of active disease (at least one of):18 25 42 46 63 96 101
 □ Advanced malignancy
 □ Chronic kidney disease
 □ Chronic heart failure,
 □ Chronic obstructive pulmonary disease
 □ New cerebrovascular disease
 □ Myocardial infarction
 □ Moderate/severe liver disease
Evidence of cognitive impairment (eg, long-term mental disorders, dementia, behavioural alterations or disability from stroke)25 42 63 73 83 96
Length of stay before this RRT call (>5 days predicts 1-year mortality)46 96

Previous hospitalisation in past year10
repeat ICU admission at this or previous hospitalisation95 (associated with a fourfold increase in mortality)
Evidence of frailty: 2 or more of these: 42 46 63 85 89 98
 □ Unintentional or unexplained weight loss (10 lbs in past year)18 83 85
 □ Self-reported exhaustion (felt that everything was an effort or felt could not get going at least 3 days in the past week)85
 □ Weakness (low grip strength for writing or handling small objects, difficulty or inability to lift heavy objects ≥4.5 kg)63
 □ Slow walking speed (walks 4.5 m in >7 s)
 □ Inability for physical activity or new inability to stand46 98
Nursing home resident/in supported accommodation33 46 96
Proteinuria on a spot urine sample: positive marker for chronic kidney disease & predictor of mortality: >30 mg albumin/g creatinine56 103
Abnormal ECG (Atrial fibrillation, tachycardia, any other abnormal rhythm or ≥5 ectopics/min, Changes to Q or ST waves18 42 97
  • MET, medical emergency team; MEW, modified early warning; RRT, rapid response team.