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

Objectives: The Supportive and Palliative Care Indicators Tool (SPICT (TM)) 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 (TM) positive; their mortality rates at 6 and 12 months of the SPICT (TM) assessment; and level of adherence to ACP documentation. Methods: A 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 (TM) positivity and compliance with ACP documentation were collected. SPICT (TM)-positive patients and mortality were tracked at 6 and 12 months, respectively. Results: Data 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 (TM)-positive, with indicators correlating with higher mortality rates at both follow-ups. Conclusions: The 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.