The development and evaluation of an inpatient palliative care admission triage tool

Background: An increased demand for palliative care services has been demonstrated, in part due to an aging population and an enhanced role of palliative care in nonmalignant illness. In particular, there is a demand for inpatient palliative care unit beds, with several services now creating waiting lists for admission. The aim of this study was to explore the development, implementation, and outcomes following the introduction of an inpatient palliative care admission triage tool. Methods: The study consisted of two phases: (1) a developmental phase, in which a purposive-sampled group participated in a series of semistructured discussions to determine the clinical and administrative criteria relevant for consideration of admission priority and (2) an implementation and evaluation phase. This second phase consisted of a 3-month trial of the tool at two inpatient palliative care units (involving three separate campuses), with subsequent evaluation of quantitative and qualitative data related to admission processes. Results: Of the 234 patients, there was a suggestion that those with less urgent needs indicated by a low admission score spent more time on the waiting list. Subsequent qualitative analysis demonstrated acceptance of the tool by clinicians, who stated it supported the decision-making processes, and was a useful education aid. Conclusion: This study represents the first reported attempt to define the priorities for a waiting list for admission to palliative care units, and demonstrates its utility in providing a transparent process for palliative care units to manage the competing needs of patients referred for care.