(QFIRST) is a multidisciplinary model of care that involves the establishment of a multidisciplinary working group to explore the development of mechanisms to ensure the full range of options available to high risk patients are investigated prior to undergoing procedures and facilitate agreement regarding treatment that aligns with the patient’s wishes. QFIRST targets high risk patients undergoing procedures in Queensland public hospitals. High risk is defined as:
- ASA Physical Status 4
- ASA Physical Status 3 and Age>70
- Clinical grounds to suspect at risk of poor outcome on basis of frailty or comorbidities
- Demonstrable limited cardiorespiratory reserve from testing (e.g. Anaerobic threshold <11ml/kg/min)
- Predicted mortality >5 per cent or double baseline
- Predicted morbidity >20 per cent
The QFirst Nurse in consultation with the patient undertakes an assessment to determine risk, frailty, disability, goals and promote understanding. The patient is provided with an information package including a ‘statement of choice’ which sets goals / identifies substitute decision maker / advanced care planning.
The QFIRST Nurse then meets with the multidisciplinary team to plan meetings, present the case and the collation of assessment, investigations, goals/values etc. The QFIRST Nurse then meets with the patient and clinician to undertake pathway planning and discuss support and follow up (refer to the attached workflow diagram).
QFIRST trial outcomes will be provided in a report to the SWAPNET Steering Committee and will guide decision making in relation to the future direction of the project.
This body of work follows on from the SWAPNet Pre-anaesthetic Evaluation Framework Project (to ensure appropriate and effective triage and assessment of patients undergoing procedures requiring anaesthetic) and specifically focusses on the management of high risk patients.