Using triggers

The acute health service’s policies make it clear that:

recognising clinical deterioration - where dying is possible, probable, or imminent - is essential for end of life care
care of the dying is urgent care.

The acute health service aims to identify patients at two critical points:

when a patient is likely to die within the next 12 months, but episodes of acute clinical deterioration may be reversible
when a patient is likely to die in the short term (within days to weeks) and clinical deterioration is probably irreversible.

Use the ‘surprise’ question:

Would you be surprised if the patient died in the next 12 months? If you would not be surprised, proactively address goals of care, limitations of medical treatment (resuscitation plan) and advance care planning
Would you be surprised if the patient died during this admission, or in the next days or weeks? If you would not be surprised, as a matter of urgency, review goals of care, limitations of medical treatment (resuscitation plan) and advance care planning.

Diagnosis of life-limiting conditions
Poor or incomplete response to medical treatment, continued deterioration despite medical treatment, or development of new clinical problems during inpatient admission
Difficult symptoms
Repeated calls to the rapid response team, particularly if the patient has been admitted for more than one week
Advanced age with increased frailty, reduced mobility and increased dependence on others to assist with activities of daily living
Moderate to severe dementia
Multisystem comorbidities
Maximal medical therapies already in place
Decline in the patient’s condition, or a clinical determination that they would not benefit from interventions such as surgery, dialysis or intensive care
Multiple recent admissions to hospital for exacerbation of a chronic condition
Unexpected or prolonged stays in hospital
Tools for condition-specific prognostic prediction⁷.

See Therapeutic Guidelines Palliative Care 2016 Version 4 on the Clinicians Health Channel at your health service

⁷For example, the Child-Pugh score for the prognosis of chronic liver disease

See Therapeutic Guidelines in Palliative Care 2016 version 4 on the Clinicians' Health Channel at your health service.

Reviewed 01 June 2017

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