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

Correspondence to Dr Hannah Featherstone, Palliative Medicine, Milford Care Centre, Castletroy, Limerick, Ireland; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Optimising triage of referrals to community palliative care can facilitate timely intervention and improve symptom control. However, there is no established triage system to implement this.

WHAT THIS STUDY ADDS

• A case mix assessment tool assessing phase of illness, Problem Severity Score and functional status can be used systematically to triage the urgency of referrals to community palliative care. Telephone triage of urgency of referral using this system corresponds to urgency of referral on in person review.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• The case mix assessment tool can be considered for use in telephone triage of urgency of referrals.

Background

Referrals to specialist palliative care (SPC) services are increasing in volume and diversity.¹ These referrals must be triaged; this is defined as ‘the analysis of the urgency of a referral and the assignment of a corresponding predefined category of urgency to the referral’.²

Enhancing triage systems can facilitate early palliative home care intervention, improve symptom control and decrease hospital deaths.³

Patient phase of illness, Palliative Care Problem Severity Score (PSS) and functional status has been proposed as a case mix model for palliative care patients.⁴ To date, there have been no studies using this case mix tool in telephone-assisted triage of patients.

Methods

This was a prospective, consecutive case series of 450 patients referred to the SPC community service in Milford Hospice in the Mid-West of Ireland. Six months of data for all patients that had first visits was collated from 1 January to 30 June 2020.

Case mix model

A case mix model was developed by Eagar et al in 2004⁴ and implemented nationally in Australia by the Palliative Care Outcomes Collaboration (PCOC). This uses three different domains unrelated to patient diagnosis, described below.

• Phase of illness

  This refers to a distinct clinical period of a patient’s illness⁵: stable, unstable, deteriorating, terminal and bereaved.

• Palliative Care Problem Severity Score (PSS)

The PSS numerically evaluates a patient and family’s problem severity across four domains:

• Pain.

• Other symptoms.

• Psychological distress.

• Family and caregiver distress.

Each domain is scored from zero to three, with zero...