Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York 10003, USA.
J Pain Symptom Manage. 2011 Nov;42(5):657-62. doi: 10.1016/j.jpainsymman.2011.06.011.
A rapid two-stage screening protocol was developed to improve referral for palliative care needs among frail elderly in the emergency department (ED).
A new triage tool was administered, with assessment tools for activities of daily living, performance, functional staging, symptom burden, and caregiver distress.
Stage One identified elderly patients meeting criteria for life-limiting conditions. Stage Two referred patients with crescendo losses in activities of daily living, high symptom burden, and caregiver distress to palliative care or hospice.
Over eight months, 1587 patients were screened, representing 22% of ED visits made by patients older than 65 years during this time period. Of these, 140 met functional decline criteria, and 51 of these needed palliative care consultation. Five patients were referred to hospice, 20 received palliative care, and 26 received no further service.
CONCLUSIONS/LESSONS LEARNED: The project shows unmet needs among elderly ED patients, and the feasibility of rapid screening and referral using a quality improvement approach. At its peak, the project accounted for half the referrals to the palliative care consultation service.
为改善急诊科（ED）虚弱老年人的姑息治疗需求转诊，开发了一种快速两阶段筛查方案。
使用新的分诊工具，并进行日常生活活动、表现、功能分期、症状负担和照顾者痛苦评估工具的评估。
第一阶段确定符合生命有限条件的老年患者。第二阶段将日常生活活动能力逐渐下降、症状负担重和照顾者痛苦的患者转诊到姑息治疗或临终关怀。
在八个月的时间里，筛查了 1587 名患者，占同期 65 岁以上患者急诊科就诊的 22%。其中 140 名符合功能下降标准，其中 51 名需要姑息治疗咨询。5 名患者被转介到临终关怀，20 名接受姑息治疗，26 名没有接受进一步的服务。
结论/经验教训：该项目表明老年 ED 患者存在未满足的需求，并且通过质量改进方法进行快速筛查和转诊是可行的。在高峰期，该项目占姑息治疗咨询服务转诊的一半。
