Screening tool for end-of-life decision-making

Researchers from the University of NSW have developed a screening tool that uses an algorithm to help identify elderly patients who are likely to die within a three-month period to potentially avoid harmful and futile treatments.

While the tool, called the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL), is predominantly being developed for emergency department triage or hospital discharge, it also has the potential to be used in other healthcare settings to initiate discussions with the elderly person and their families about end-of-life care planning.

Lead researcher Magnolia Cardona-Morrell, an epidemiologist with UNSW Medicine's Simpson Centre for Health Services Research, told the Sydney Morning Herald that while CriSTAL had not been designed for general practitioners, it could encourage GPs to begin discussions about advanced care directives.

CriSTAL consists of a 29-item screening list that can be completed by a nurse or a doctor before hospital admission and takes account of factors such as vital signs, cognitive impairment, recent hospitalisations, measures of frailty and the presence of active disease such as cancer or chronic kidney or liver disease.

The tool is being retrospectively tested using a case-control study design of deaths reported from rapid response team (RRT) attendances at Liverpool Hospital from 2012 to 2013. The validated tool will then be considered for prospective administration as part of the admissions procedure in emergency and after the RRT calls on general wards.

In a paper published last week in BMJ Supportive & Palliative Care, the researchers write that the 29 data points can be easily extracted from existing electronic or paper clinical notes, and that automation of CriSTAL and its scoring would facilitate its use at the time of admission.

“Potential uses include as a clinical support tool for decision-making on triage to appropriate end–of-life care facilities; to prevent death in some cases; and to examine variation in risk-of-death levels, differences in admission practices, and inform triage policies across hospitals as a first step into cost-effectiveness and patient satisfaction studies,” they write.

CrisTAL will be trialled in selected hospital emergency departments in Sydney this year and will include communication training for clinicians.

Posted in Australian eHealth

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