A Triage System for a High-Volume Home-Based Palliative Care Unit in Urban India

Background: The Palliative Care Service of the Tata memorial Centre caters to a monthly average of 100 patients on home care. An average of 25 patients are cared for at home in a radius of around 30 km from the hospital, over 6 working days. From May 2010, a system was introduced to prioritize patients who were planned for home care as “low”, “Medium” and “high” with an aim to deliver home care in 3 days, 7 days and 10 days respectively in an attempt to effectively optimize the available (limited) resources for maximum benefit to the patients. Methods: With an aim to review the triage system and identify factors that could possibly influence the priority given to a patient, records of patients (n=82; median age 50 years) currently on home care and coded, were analyzed. Priorities given were recorded against symptoms, psychological, social, spiritual distress, along with demographic data and analysed using SPSS for any correlation with triage. Multiple regression analysis was done to identify factors significantly affecting the triage. Results: 55 (67.1%) were coded “low”, 19 (23.2%) were coded “medium” and 8 (9.8%) were coded high priority. Median time to home care was 3 days for high priority, 8 for “medium” priority and 11 for “low” priority patients. Correlation using chi-square test revealed 4 factors – Symptom load (p=0.001), ECOG (p=0.007), Psychological distress (p=0.000), Social distress (p=0.008) which had highly significant association with a high priority. On multiple regression analysis, the model was good to fit (R² 0.774, p=1.000) and symptom load (p=0.009), psychological (p=0.016) and social distress (p=0.000) were the only significant factors associated with a “high priority”. The calculated predicted triage priority matched well with the observed triage priority 93.9%. Conclusions: A triage system is necessary in a high volume domiciliary care unit with resource limitations. Domiciliary palliative care means additional cost to the hospital but is very helpful for the patient. The results have helped us define the triage system and attempts are on to study patient satisfaction with the current model and to develop a model for home care triage relevant to resource poor palliative care settings.