18 Palliative medicine at the front door, an impact assessment

Introduction Around one third of medical inpatients are in the last year of life. Identification of these patients is challenging. Palliative medicine trigger tools have been developed to identify this cohort with limited success. The objective of the project was to validate the use of a novel palliative medicine trigger tool to identify and assess patients who are likely to be in the last year of life within the emergency department and assess the impact on the patients admission. Methods Prospective mixed method approach over 10 weeks. Over 300 patients were identified, with 126 being appropriate within the scope of this project. Daily review of ED patients notes with trigger tool followed by patients being triaged into face to face assessment and virtual assessment which occurred within 24 hours of presentation to ED. Assessment completed by a Physician Associate with specialist interest in palliative medicine with Palliative medicine consultant review as required. Results This data was analysed using excel and reviewed by an external statistician. Statistical analysis showed a relationship between early specialist palliative care assessment and reduced length of stay for both face to face and virtually assessed patients (PConclusion Early specialist palliative medicine input to patients identified as having palliative needs within the emergency department, reduces length of stay when compared to usual referral pathways within a district general hospital. Conclusion of trigger tool validity in predicting the last year of life will become apparent at the end of the study period.