Effects of Nurse-Led Triage Tool to Initiate Palliative Care Consult for Cancer Patients Being Treated in the Emergency Department

BACKGROUND: Cancer is currently the second leading cause of death in the United States and has a significant impact on our society in the United States, as well as across the world. Evidence shows that cancer patients seeking care in the ED are experiencing a delay in palliative care consults, resulting in a delay of care and increased length of stay.

LOCAL PROBLEM: The project was completed in the emergency department at a level-one trauma center in the southeast region of the United States. The problem in practice is that adult cancer patients coming to the emergency department due to uncontrolled cancer-related symptoms are not receiving palliative care consults early in their hospital stay, if at all.

METHODS: The Model for Improvement provided the framework for implementing the creation of a triage tool utilized in the emergency department and utilizing PDSA (Plan-Do-Study-Act) cycles allowed for a thorough critique of the palliative triage tool for cancer patients and for correcting issues during implementation.

INTERVENTIONS: A nurse-led triage tool was created that helped identify cancer patients seeking treatment for uncontrolled symptoms related to their diagnosis. A palliative consult was automatically created if two or more symptoms were selected from the pre-made list.

RESULTS: The palliative tool triggered 83 consults during January – April 2024. The project group had a lower percentage of deceased patients (22.9%) than the control group (36.4%), indicating the tool's effectiveness in identifying early palliative needs and showing clinical significance.

CONCLUSIONS: The nurse-led tool was clinically significant in early identifying palliative needs for cancer patients with uncontrolled cancer symptoms. Earlier palliative intervention care allows the opportunity to improve patient care and outcomes, improve patients' quality of life, improve patient satisfaction, improve patient flow within the hospital, and decrease the patient's cost burden. Sustainability plans include modifying the triage tool to include other disease processes.