A test devised by Sydney researchers to determine the likelihood of a patient's death within the next 30 days will be trialled in local hospitals from March. 
 
 The Criteria for Screening and Triaging to Appropriate aLternative care, or CriSTAL, developed by University of New South Wales researcher Magnolia Cardona-Morrel, would take into account 29 different criteria to assess whether it was worthwhile carrying out life-saving treatments and procedures. 
 
 Careful criteria: The CriSTAL test is designed to help terminally ill and elderly patients choose whether to undergo further treatment. Photo: Greg Newington 
 
 Dr Cardona-Morrel said the test was designed to help doctors begin a conversation with terminally ill patients, particularly elderly patients, as to whether they would like to continue to receive treatment and where they would prefer to die. 
 
 "The test is easy to administer and the [answers] are readily available in the patient's clinical records and it can be completed in five or 10 minutes," she said. "The score by no means decides the treatment." 
 
 She said the aim of CriSTAL was to stop the common practice of terminally ill patients being put through unnecessary treatments and surgery in an attempt to save their lives. 
 
 "Doctors are keeping people alive because they can," Dr Cardona-Morrel said. "Hospitals are full of elderly people living longer because technology allows it. A lot of them would like to die at home." 
 
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 Dr Cardona-Morrel said the results of the test were designed as a tool for doctors to use in discussing the available options with patients. 
 
 "When a patient is diagnosed with a terminal illness their first question is always, 'Doctor, how long do I have left?," she said. 
 
 "Doctors see their role as to protect their patients so they don't like to give them sad or bad news." 
 
 The test, which was presented at a medical conference in the US recently, has been welcomed by medical professionals around the world. 
 
 "I had lots of nurses and doctors standing there saying, 'We have been waiting for a tool like this for years, when can we start using it?'" she said. 
 
 "To me that is an indication there is a need out there." 
 
 Once the score is determined the doctor could have a transparent conversation with the patient about their wishes. 
 
 She said once the score is determined the doctor could have a "transparent conversation" with the patient about their wishes and give them all the options available, including palliative care at home, or in a hospice. 
 
 The test is undergoing retrospective testing, looking at patients who have died and seeing if it would have been able to calculate the time they had left, before it is introduced into hospitals. 
 
 Dr Cardona-Morrel said the test was already being used in some Irish and US hospitals, and she hoped it would be in use in Australian hospitals by the end of the year. 
 
 Even though the test has not been designed for general practitioners to use, Dr Cardona-Morrel said she hoped it would encourage them to keep an eye out for the signs of a terminally ill patient and begin discussions about advanced care directives before the patient became too unwell. 
 
 The full list of criteria can be found in the paper by Dr Cardona-Morrell and Ken Hillman in the British Medical Journal. ||||| Researchers at the University of New South Wales, in Sydney, Australia, insist that the checklist does not intend to withhold treatment but said it intends to stop “intrusive, expensive and ultimately pointless medical procedures”. 
 
 The programme, dubbed CriSTAL (Criteria for Screening and Triaging to Appropriate alternative care), will be trialled in Sydney A&Es later this year to identify patients deemed likely to die within three months of going into hospital. 
 
 Among the points listed as risk factors is low blood pressure, a weak pulse, history of disease, dementia, repeat hospitalisation, weakness, heart failures and sudden weight loss. 
 
 Dr Magnolia Cardona-Morrell, who led the research at the university’s Simpson Centre for Health Services Research, said: “Most terminally ill people want to die at home, but in fact three quarters end up dying in acute hospitals, often after intrusive, expensive and ultimately pointless medical procedures. 
 
 The study's authors claim the list would improve care by enabling doctors to be honest about patients' chances with families and giving them greater choice “Current acute hospital systems often fail to recognise or cater to the needs of people for whom death is imminent and unavoidable. They are geared for aggressive treatment and emergency resuscitation, not peaceful, harm-free transitions. 
 
 “Elderly people who are dying need to be protected from heroic but intrusive live-saving hospital interventions that often only prolong suffering rather than enhance quality of remaining life.” 
 
 The checklist is only meant to be used for patients aged 65 or over and a number of factors must combine for death to be considered “unavoidable”. 
 
 A spokesperson for the University of New South Wales said CriSTAL had been compiled using an “extensive review of the strengths and weaknesses of medical literature that attempts to diagnose dying”. Most of the existing tools were found to rely on clinical judgment, subjective assessments and value judgments. 
 
 A paper describing the assessment procedure has been published in the BMJ Supportive and Palliative Care journal. 
 
 In it, Dr Cardona-Morrell and Ken Hillman, a professor of intensive care, argue that a balance must be struck between limited health resources, families’ expectations and the dignity of the patient. 
 
 CrisTAL is being trialled in selected hospital emergency departments in Sydney this year. The programme includes communication training for medical staff, so they can sensitively discuss with dying patients and their carers the limitations of medical treatment and their choices. 
 
 Dr Cardona-Morrell said medicine “cannot work miracles” against old age and multiple chronic conditions in elderly patients. 
 
 Her co-author Professor Hillman believes the management of elderly patients at the end of their lives is “one of the greatest challenges facing health care”. 
 
 “Most patients and their carers do not wish to be admitted to a hospital at the end of their life and this is a major contributor to the unsustainable costs of health care,” he said. 
 
 No such list exists in Britain but the director of Age UK said the move would be welcomed on the condition that discussions with relatives were handled “compassionately”. 
 
 “The best time to begin discussing end of life issues and an older person’s wishes is well in advance, when they are fit and well, but we acknowledge that this isn't always possible,” Caroline Abrahams added. 
 
 “The ability to accurately identify people entering hospital who are nearing the end of their lives ought to help ensure they receive high quality care, appropriate to their needs, so we welcome this development. 
 
 "However, in practice, access to good end of life care services remains extremely variable and discussions with older people and their families about this most difficult of subjects are not always handled sensitively and well.” ||||| A test to determine if elderly patients will die within 30 days of being admitted to hospital has been developed by doctors to give them the chance to go home or say goodbye to loved ones. 
 
 Health experts say the checklist will prevent futile and expensive medical treatments which merely prolong suffering. 
 
 The screening test looks at 29 indicators of health, including age, frailty, illness, mental impairment, previous emergency admissions and heart rate and produces a percentage chance of death within one month and 12 weeks. 
 
 Researchers say the aim of Critera for Screening and Triaging to Appropriate aLternative care, or CriSTAL for short, is to kick-start frank discussions about end of life care, and minimise the risk of invasive ineffective treatment. 
 
 “Delaying unavoidable death contributes to unsustainable and escalating healthcare costs, despite aggressive and expensive interventions,” said lead author Dr Magnolia Cardona-Morrel, a researcher at the University of New South Wales. 
 
 “These interventions may not influence patient outcome; often do not improve the patient’s quality of life; may compromise bereavement outcomes for families; and cause frustration for health professionals.” 
 
 Earlier this week Professor Sir Mike Richards, the Chief Inspector of Hospitals for the Care Quality Commission, warned that dying patients are receiving wide variations in care because of hospital failure to replace the Liverpool Care Pathway. 
 
 The controversial end-of-life plan was scrapped after a review of the regime found that hospital staff wrongly interpreted its guidance for care of the dying, leading to patients being drugged and deprived of fluids in their last weeks of life. 
 
 The Health Select Committee is currently examining palliative and end of life care in the wake of the LCP controversy. 
 
 However the new test aims to provide a ‘starting point’ for ‘honest communication with patients and families about recognising that dying is part of the life cycle’ 
 
 Researchers looked at 112 peer-reviewed studies to find out which tests and questions were the best predictors of death. 
 
 They claim the test will help doctors and nurses who are often under great pressure from family members and society to prolong the life of patients at all costs. 
 
 “While there are accepted policies for de-escalating treatment in terminally ill patients, there are also inherent and societal pressures on medicine to continue utilising technological advances to prolong life even in plainly futile situations,” said Dr Cardona-Morrel. 
 
 “Training for nurses and doctors in the use of the screening tool and in approaching patients and families with concrete information about inevitability of death and lack of benefit of further intensive treatment are paramount.” 
 
 Most patients end up dying in hospital, even though that is not their stated preference, when asked. 
 
 Caroline Abrahams, Charity Director at Age UK, said:“The best time to begin discussing end of life issues and an older person’s wishes, is well in advance, when they are fit and well, but we acknowledge that this isn’t always possible. 
 
 “The ability to accurately identify people entering hospital who are nearing the end of their lives ought to help ensure they receive high quality care, appropriate to their needs, so we welcome this development. However, in practice, access to good end of life care services remains extremely variable and discussions with older people and their families about this most difficult of subjects are not always handled sensitively and well. 
 
 “So as well as improved analysis and triage of people’s needs, better training and support for medical staff in speaking compassionately with older people and their families about end of life care is also required. “ 
 
 By giving families and patients some options about the preferred place of death, the test could also help terminally ill elderly people choose to go home, the authors said. 
 
 The checklist is yet to be tested but the researchers hope it will eventually be used for all hospital admissions. 
 
 The research was published in the BMJ Open publication Supportive & Palliative Care.
– Seniors had better brace themselves: Some US hospitals are now administering the "death test," which estimates an elderly patient's chance of dying over the next 30 days. Invented in Australia, the test weighs 29 different criteria—including blood pressure, respiratory rate, and medical history—to determine whether hospitalization is worthwhile or the patient should return home or go to a hospice, the Sydney Morning Herald reports. The idea is to prevent needless and expensive procedures while allowing patients to spend their last days with loved ones. "Most terminally ill people want to die at home, but in fact three quarters end up dying in acute hospitals, often after intrusive, expensive, and ultimately pointless medical procedures," says study author Magnolia Cardona-Morrell, the Independent reports. The test also aims to take pressure off doctors and nurses to prolong patients' lives "at all costs," the Telegraph reports. "I had lots of nurses and doctors standing there saying, 'We have been waiting for a tool like this for years, when can we start using it?'" says Cardona-Morrell, whose work was presented recently at a US medical conference. "To me that is an indication there is a need out there." She says the test takes just five or 10 minutes, and helps doctors have a more "transparent" conversation with patients. Called CriSTAL, it's now being tested to see if it would have predicted the future of patients who have since died. Then it may be used in more hospitals. (In related news, a study says those who feel younger than their age will live longer.)