2004 - 2007 - Cicely Saunders Institute - King's College London

international debate, as well as leading to local service
recommendations.
The results from the project are currently being disseminated
within the hospital trust but have already led to:
• Agreed specific referral criteria to palliative care
(see table 4.1);
• A pilot parallel heart failure/palliative care
outpatient service;
• Discussions between ward staff and palliative
care staff regarding available resources;
• Review of psychological support to patients.
• Review of information available to patients
All cardiac patients being referred to the palliative care team must have:
• been reviewed by the Heart Failure team (x81012);
• know they have a diagnosis of heart failure;
• both patient and medical team must agree to the referral.
IN ADDITION one or more of the following merit referral:
• Symptomatic (e.g. breathless at rest or on minimal exertion) despite optimal treatment;
• Three or more admissions for heart failure within the past year;
• Heart failure when hospital admission may not be the best/only/preferred option;
• Stage IV patients (i.e. daily activities limited by dyspnoea) for whom hospice inpatient treatment may be
of benefit, either immediately or in the future;
• On optimal therapy but with marked or deteriorating physical or psychological symptoms*;
• Those who may benefit from palliative day care or counselling*.
* Where only psychological issues are present consider referral to psychology
These guidelines have been compiled from a one year study undertaken at Guy’s and St. Thomas’ Hospital in
collaboration with the Department of Palliative Care, Policy and Rehabilitation, Kings College London and St.
Christopher’s Hospice. The study was supported by the Guy’s and St. Thomas’ Charity.
Table 4.1: Referral criteria to Palliative Care at GSTT for patients with Heart Failure*
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