title: A simplified screening tool to identify seriously ill patients in the Emergency Department for referral to a palliative care team.
abstract: BACKGROUND
  The aims of this study were to evaluate the feasibility of an Emergency Department (ED)-initiated screening to identify seriously ill patients in need of palliative care (PC) and to develop a simplified screening tool (SST).
  
  
  METHODS
  Eligible patients with known diagnosis of chronic heart, lung, liver, and kidney failures, progressive neurological diseases or advanced cancer, awaiting to be hospitalized after an ED visit, were assessed with the screening tool from the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI).
  
  
  RESULTS
  Out of 1497 patients with an ED visit, 485 were hospitalized, and 257 of them met the inclusion criteria. Of 257 enrolled patients, 91 (35%) were identified as in need of PC. Comparing patients with 4 positive criteria to those with <4, the general clinical indicators more frequently positive were: ≥1 admission within the last 12 months (P<0.001); hospital admission from or awaiting admission to health care services (HCS)/Hospice (P<0.001); cachexia (P<0.012); home oxygen use (P<0.001); dialysis (P<0.008). A SST was developed to identify patients in need of PC when a Palliative Performance Scale score <50 was present with at least one of the following indicators: ≥1 admission within the last 12 months; hospital admission from HCS; awaiting admission to HCS/Hospice; dialysis; home oxygen use; non-invasive ventilation. This SST showed a good agreement with the SIAARTI one as sensitivity (97.8%), specificity (92.8%), and accuracy (94.5%).
  
  
  CONCLUSIONS
  Our study estimated that over one-third of the people with chronic diseases awaiting to be hospitalized after an ED visit were in need of PC and can be identified with this easy-to-use, non-disease-specific SST.
authors.affiliation: Pain Management and Palliative Care, Department of Anesthesia and Intensive Care, Città della Salute e della Scienza, Turin, Italy - paolo.cotogni@unito.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cotogni
authors.affiliation: Pain Management and Palliative Care, Department of Anesthesia and Intensive Care, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: DE Luca
authors.affiliation: Section of Clinical Epidemiology, Center for Epidemiology and Oncologic Prevention (CPO Piemonte), Città della Salute e della Scienza, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Filippini
authors.affiliation: University of Turin, Turin, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Gili
authors.affiliation: Department of Health Management, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Scarmozzino
authors.affiliation: Section of Clinical Epidemiology, Center for Epidemiology and Oncologic Prevention (CPO Piemonte), Città della Salute e della Scienza, Turin, Italy.
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brazzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010348:Patient Care Team; D018579:Patient Selection; D011446:Prospective Studies; D012017:Referral and Consultation; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods*