title: The impact of implementing referra criteria on the pattern of referrals and admissions to a palliative care program in Saudi Arabia.
abstract: Referral criteria were developed to rationalize transfer-of-care requests and referrals to a hospital-based palliative care program (PCP) in Saudi Arabia. This study aimed to explore the impact of an approved referral criteria policy on the pattern of referrals to a PCP. Two periods, 19 months each, were identified: one before the implementation of the referral criteria (precriteria), and the other started 6 months later (post-criteria). During the two study periods, the palliative care unit (PCU) received 620 admissions related to 518 patients. Of them, 314 (50.6%) were in the precriteria period. A total of 1,216 new cancer referrals were received by the PCP during the study period, with 53.2% received during the precriteria period. The postcriteria period was associated with a proportional increment in admissions to the PCU through the emergency room (P <0.001) by the palliative care team (P = 0.001) for patients whose care had been previously transferred completely to the PCP. The median survival of referred patients decreased from 2.27 months during the precriteria period to 1.73 months during the postcriteria period (P = 0.0051). The findings suggest that the implementation of the referral criteria policy was associated with a more rational pattern of transfer-of-care referrals to the PCP. However, more educational efforts and organizational actions are needed to prevent delayed referrals of cancer patients to palliative care teams.
authors.affiliation: From the Section of Palliative Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. malshahri@kfshrc.edu.sa
authors.forename: Mohammad Z
authors.initials: MZ
authors.lastname: Al-Shahri
authors.forename: Mahmoud Y
authors.initials: MY
authors.lastname: Sroor
authors.forename: Samy A
authors.initials: SA
authors.lastname: Alsirafy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care; D010343:Patient Admission / Q000592:standards*; D010348:Patient Care Team; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012529:Saudi Arabia; D015996:Survival Rate; D055815:Young Adult