Implementation and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT™) in acute care

Abstract

AbstractObjectivesThe Supportive and Palliative Care Indicators Tool (SPICT™) has been used to identify patients at risk of deteriorating and dying within 1 year. Early identification and integration of advance care planning (ACP) provides the opportunity for a better quality of life for patients. The aims of this study were to identify the number of patients who were SPICT™ positive; their mortality rates at 6 and 12 months of the SPICT™ assessment; and level of adherence to ACP documentation.MethodsA retrospective audit of the Supportive and Palliative Care database was conducted at an acute aged care precinct in a major metropolitan tertiary referral hospital in New South Wales, Australia. Data comprising demographics, clinical conditions, SPICT™ positivity and compliance with ACP documentation were collected. SPICT™‐positive patients and mortality were tracked at 6 and 12 months, respectively.ResultsData from 153 patients were collected. The mean age of the patients was 84.1 (±7.8) years, and the length of hospital stay was 10 (±24.7) (range 1–269) days. Approximately 37% were from residential care, and 80% had family deciding on their care. About 15% died during hospitalisation, and 48% were discharged to a care facility. The ACP documentation showed various levels of completion. Mortality rates at 6 and 12 months were 36% and 39%, respectively. Most patients (99%) were SPICT™‐positive, with indicators correlating with higher mortality rates at both follow‐ups.ConclusionsThe study emphasises the critical need for addressing ACP and palliative care among older patients with life‐limiting conditions. It underscores the importance of timely discussions, documentation, and cessation of futile interventions.