A simplified screening tool to identify seriously ill patients in the Emergency Department for referral to a palliative care team.

BACKGROUND

The aims of this study were to evaluate the feasibility of an Emergency Department (ED)-initiated screening to identify seriously ill patients in need of palliative care (PC) and to develop a simplified screening tool (SST).

METHODS

Eligible patients with known diagnosis of chronic heart, lung, liver, and kidney failures, progressive neurological diseases or advanced cancer, awaiting to be hospitalized after an ED visit, were assessed with the screening tool from the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI).

RESULTS

Out of 1497 patients with an ED visit, 485 were hospitalized, and 257 of them met the inclusion criteria. Of 257 enrolled patients, 91 (35%) were identified as in need of PC. Comparing patients with 4 positive criteria to those with <4, the general clinical indicators more frequently positive were: ≥1 admission within the last 12 months (P<0.001); hospital admission from or awaiting admission to health care services (HCS)/Hospice (P<0.001); cachexia (P<0.012); home oxygen use (P<0.001); dialysis (P<0.008). A SST was developed to identify patients in need of PC when a Palliative Performance Scale score <50 was present with at least one of the following indicators: ≥1 admission within the last 12 months; hospital admission from HCS; awaiting admission to HCS/Hospice; dialysis; home oxygen use; non-invasive ventilation. This SST showed a good agreement with the SIAARTI one as sensitivity (97.8%), specificity (92.8%), and accuracy (94.5%).

CONCLUSIONS

Our study estimated that over one-third of the people with chronic diseases awaiting to be hospitalized after an ED visit were in need of PC and can be identified with this easy-to-use, non-disease-specific SST.