姑息治疗紧急需求应对（RUN-PC）分诊工具的试点实施

Pilot Implementation of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool.

作者信息

Russell Bethany, Philip Jennifer, Phillips Janet, Smith Amanda, Collins Anna, Sundararajan Vijaya

机构信息

Palliative Nexus Research Group (B.R., Je.P., A.C.), University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Palliative Care (B.R., Je.P.), St Vincent's Hospital Melbourne, Melbourne, Australia; Victorian Comprehensive Cancer Centre (Je.P.), Melbourne, Australia; Department of Palliative Care (Je.P.), Royal Melbourne Hospital, Melbourne, Australia.

出版信息

J Pain Symptom Manage. 2024 Mar;67(3):260-268.e2. doi: 10.1016/j.jpainsymman.2023.12.012. Epub 2023 Dec 13.

DOI:10.1016/j.jpainsymman.2023.12.012

PMID:38101490

Abstract

CONTEXT

Specialist palliative care services must balance provision of needs-based care within resource restraints. The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based, 7-item prioritization tool, with recommended response times for any given score.

OBJECTIVES

To investigate the acceptability and appropriateness of the RUN-PC Triage Tool implemented into clinical practice.

METHODS

A single-arm, multisite, prospective implementation pilot conducted at 12 community/inpatient palliative care services, using Quality Improvement methodology with Plan-Do-Study-Act cycles. Data collected for each triage episode included demographics, scoring, user feedback and clinical outcomes. Group differences were tested by chi-squared, Wilcoxon Rank Sum or Kruskal Wallis tests.

RESULTS

A total of 5418 triage episodes were captured, 1509 with outcome data. Referrals to inpatient services were of higher acuity than those to community (median score 24 vs. 14). Whilst high numerical scores were unusual, a significant proportion of cases were clinically urgent. Admissions occurred within recommended response times in over 80% of triage episodes; 5.8% of referred patients died before being admitted. Users reported the tool was easy to complete (99.3% of applications), rarely requiring additional time (0.07%), and appropriate in its triage determination (96.0% of applications).

CONCLUSION

The RUN-PC Triage Tool is feasible to implement, with high clinician acceptability and virtually no additional time required. The recommended response times are feasible and highlight target areas for improvement. Implementation of the tool enables palliative care services to better characterize their referral population and, in turn, improve transparency around access to care.

摘要

背景

专科姑息治疗服务必须在资源限制的情况下平衡提供基于需求的护理。姑息治疗紧急需求应对（RUN-PC）分诊工具是一种新颖的、基于证据的7项优先排序工具，针对任何给定分数都有推荐的响应时间。

目的

调查RUN-PC分诊工具在临床实践中的可接受性和适用性。

方法

在12个社区/住院姑息治疗服务机构进行了一项单臂、多地点、前瞻性实施试点，采用质量改进方法和计划-实施-研究-行动循环。为每个分诊事件收集的数据包括人口统计学、评分、用户反馈和临床结果。通过卡方检验、威尔科克森秩和检验或克鲁斯卡尔-沃利斯检验来检验组间差异。

结果

共记录了5418次分诊事件，其中1509次有结果数据。转介到住院服务的患者病情比转介到社区服务的患者更严重（中位数评分分别为24和14）。虽然高分情况不常见，但相当一部分病例在临床上很紧急。超过80%的分诊事件在推荐的响应时间内入院；5.8%的转介患者在入院前死亡。用户报告该工具易于完成（99.3%的应用情况），很少需要额外时间（0.07%），并且在分诊判定中是合适的（96.0%的应用情况）。