50 Developing a triage process for the charing cross hospital specialist palliative care team

Introduction The Specialist Palliative Care Team (SPCT) within Imperial College NHS Trust is a multidisciplinary advisory service providing specialist palliative care to inpatients across its three sites. The Charing Cross Hospital SPCT has the highest number of referrals by site, receiving 1355 referrals between 2020–2021. New referrals are made to the team electronically via EPRO. There was no structured approach for new referrals to the Charing Cross SPCT. It was unclear whose responsibility it was to check the urgency of new referrals. This meant team members were not necessarily leaving themselves with capacity to see referral requiring urgent review, meaning they were not responded to in an appropriate time. A Triage Practitioner role was created to address this. Triage is an important skill for junior nurses and doctors to develop. Having a supported and structured triage process would allow members of staff to develop triage competencies in a safe way. Aims and objectives of the research project or activity To develop a triage process for new referrals to the Specialist Palliative Care Team (SPCT) at Charing Cross Hospital To have a structured approach to urgent referrals and queries for the SPCT at Charing Cross Hospital To improved identification of urgent referrals who require same day review Improve educational opportunities for doctors and junior nurses to develop triage skills in a safe and supported way Method or approach A data collection tool was designed in Microsoft Excel which underwent several improvements using PDSA methodology. Data was collected first retrospectively prior to introduction of a Triage Practitioner on response time to new referrals, whether the referral required same day review, whether written acknowledgement of referral was left the same day, and whether patients died before advice could be given or review conducted. A staff survey was conducted pre implementation of Triage Practitioner of team attitudes and understanding about triage and morale. A draft Triage Practitioner SOP was created including a triage tool. A Triage Practitioner was then allocated on selected days. Their role was to triage new referrals and provide telephone advice, rather than review their case load. Urgent reviews of their case load were handed over to other members of the team. Data was then collected on the same parameters on referrals received during the triage days. Findings A total of 36 referrals across 5 non-triage days and 41 referrals across 9 triage days were analysed. There was a 95% acknowledgement rate of referrals on triage days with 54% containing written advice and 39% given telephone advice. On non-triage days there was an acknowledgement rate of 69%, 40% had written advice and 0% given telephone advice. During triage days no acknowledgements were performed out of hours, on non-triage days 2 acknowledgements were performed out of hours. 8 patients were identified as requiring urgent review with all receiving same day review on triage days, whereas on non-triage days 1 patient was identified as requiring urgent review and was not reviewed the same day. On triage days no patients died prior to receiving advice or face to face review, whereas on non-triage days 1 patient died prior to any advice given and 2 patients died prior to face-to-face review. Verbal feedback from SPCT members was that having a Triage Practitioner was a useful role. It allowed team members to focus on their current case load, and not worry about missing urgent new referrals. The project was presented at the Palliative Care Team Clinical Governance Meeting with overwhelmingly positive feedback. Key messages Having a Triage Practitioner and standardised triage process of new referrals has improved the ability of the SPCT to give same day advice, identify and review new urgent referrals, therefore improving timely patient care. During triage days no acknowledgements were performed out of hours indicating that having a Triage Practitioner facilitates better time management of team members. Feedback from those trialling as Triage Practitioners said their confidence and competence in handling advice calls and triage skills increased. Additionally, having direct contact with the referring teams enabled the Triage Practitioner to identify members of staff/teams who had high anxiety about caring for dying patients, allowing future educational interventions from the SPCT to be targeted to those specialties needing more support. The next steps are for the Triage SOP to be formalised, more team members to be trained as Triage Practitioners and a post implementation staff survey to be conducted.