PPF46 ‘Pallitrigger’: a novel palliative screening tool used within the emergency department to identify patients in their last year of life

<h3>Objectives</h3> Early palliative care in the emergency department (ED) improves patient outcomes. Despite NICE highlighting the need for a screening tool, none is widely used. We developed and internally validated ‘Pallitrigger,’ a 5-point tool aimed at identifying patients likely in their last year of life. <h3>Methods</h3> Pallitrigger screens for recent admissions, disease progression, worsening performance status, severe symptoms, or red flag symptoms. A positive result is recorded if any one criterion is met. Over a 10-week period (27/03/23 to 31/05/23), we prospectively tested Pallitrigger in a single ED. Outcomes were compared with a historical cohort receiving usual palliative care over a similar 10-week period in 2022 and 2023. The primary outcome was 12-month mortality. An external statistician analysed associations using Chi-square, t-tests, Mann Whitney, Cox regression, and Kaplan-Meier survival curves. <h3>Results</h3> Of 123 patients testing positive, 81 (66%) had died at 12 months. Mortality was significantly associated with disease progression (p=0.03), worsening performance status (p=0.02), and severe symptoms (p=0.03). Shorter survival was linked to worsening performance (p&lt;0.001), severe symptoms (p=0.02), and multiple positive triggers (p&lt;0.001). Patients with both worsening performance and severe symptoms had the shortest survival. Length of stay (LOS) was reduced by a median of 9 days in Pallitrigger-positive patients reviewed physically, compared to the historical cohort (median LOS 7 vs. 16 days). <h3>Conclusions</h3> Pallitrigger shows promise in identifying ED patients in their final year of life. External validation is recommended to confirm predictive accuracy and assess the impact of early palliative intervention.