Quality of referrals to specialist palliative care and remote patient triage — a cross-sectional study

Abstract

Purpose Choosing the optimal moment for admission to palliative care remains a serious challenge, as it requires a systematic identification of persons with supportive care needs. Despite the screening tools available for referring physicians, revealing the essential information for preliminary admission triage is crucial for an undisturbed qualification process. The study was aimed at analysing the eligibility criteria for specialist palliative care disclosed within provided referrals, expanded when necessary by documentation and/or interview. Methods Referral forms with the documentation of 300 patients consecutively referred to the non-profit in-patient ward and home-care team in Poland were analysed in light of prognosis, phase of the disease and supportive needs. Results Half of the referrals had the sufficient information to make a justified preliminary qualification based solely on the delivered documentation. The majority lacked performance status or expected prognosis. Where some information was revealed, two-thirds were in a progressing phase of the disease, with a within-weeks life prognosis. In 53.7%, no particular reason for admission was given. Social problems were signalled as the only reason for the admission in 7.7%. Twenty-eight percent were labelled as “urgent”; however, 52.4% of them were triaged as “stable” or disqualified. Patients referred to a hospice ward received complete referral forms more often, containing all necessary information. Conclusions General physicians need practical tips to facilitate timely referrals and unburden the overloaded specialist palliative care. Dedicated referral forms extended by a checklist of typical patients’ concerns should be disseminated for better use of these resources.

Examining Variability in Intra-Hospital Patient Referrals to Specialized Palliative Care: A Comprehensive Analysis of Disciplines and Mortality

“…In our study, we were able to gain important insights into reasons for referral, which were assessed using standardized referral forms, including patients referred mainly for social problems. These additional data, in combination with clinical information, provide valuable insights, especially considering the burden on SPC and the potential role of general home care, social support, and long-term care facilities [19].…”

“…For example, in a recent study, Gradalski and Kochan (2023) compared referral forms with the documentation of 300 patients referred to SPC and found that half of the referrals did not have sufficient information to justify prequalification on the basis of the documentation alone. As a result, the authors recommended that referral forms should be expanded to include a checklist of typical patients' concerns [19].…”