Is this patient approaching the end of life?
Determining with certainty if a patient is in their final year of life can be difficult if they are following a frailty or organ failure trajectory13. A range of tools exist to help identify people approaching the end of life (such as SPICT – Supportive and Palliative Care Indicators Tool), but they may be cumbersome to use in the ED14.
Ask yourself: “Would I be surprised if this patient died in the next year?”
If the answer is No, then the patient may be approaching the end of life and you should consider whether a palliative care framework is appropriate. However, this ‘surprise’ question has poor sensitivity and specificity for non-cancer trajectories such as frailty15. Instead, a range of clinical indicators may be helpful16:
- Two or more unplanned hospital admissions in the past 6-12 months
- Persistent and recurrent infections
- Weight loss of 5-10% in the past 6 months
- Multiple morbidity in addition to frailty
- Combined frailty and dementia
- Delirium
- Increased frequency of falls
- Rapidly rising frailty score
- Escalating patient, family or service provider distress.