Using the Supportive and Palliative Care Indicators Tool (SPICT) to prioritise frail inpatients for Anticipatory Care Planning

Introduction

Patients with frailty who have emergency admissions are at risk of mortality and may benefit from Anticipatory Care Planning (ACP). Appropriate identification, to target limited resource in an in-patient environment can be challenging. We conducted a prospective study on a cohort of frail in-patients with a hospital admission of ≥ 72 hours duration.  We aimed to evaluate the effectiveness of the SPICT tool alongside Clinical Frailty Score (CFS) as a predictor of mortality to improve our targeting of patients for ACP.

Method.

On a single day a SPICT form was completed prospectively for each inpatient on 3 hospital inpatient wards (Complex Frailty Unit, General/Orthopaedic Rehabilitation, Step-Down Unit).  Patients were deemed SPICT positive if they scored on ≥ 2 General Indicators and ≥ 2 Clinical Indicators. CFS was also recorded. Electronic records of this patient cohort were followed up for 9 months.

Results

Of 66 inpatients, 58 (87.9%) were aged ≥ 65 years and had a CFS ≥ 4. Mode CFS value = 6 (23 patients, 39.7%).  32 (55.2%) were SPICT positive; 26 (44.8%) SPICT negative.  At 3 months follow-up SPICT had Positive Predictive Value (PPV) 40.6% and Negative Predictive Value (NPV) 84.6% for mortality. At 6 months PPV = 56.3%; NPV = 80.8%. At 9 months PPV = 59.4%; NPV = 76.9%.  SPICT negative patients with CFS 6 had mortality risk of 14.3% at 3, 6 and 9 months follow-up respectively.  SPICT positive patients with CFS 6 had mortality risks of 50% at 3 months and 62.5% at 6 and 9 months.

Conclusion

SPICT is a predictor of mortality in patients with frailty during unplanned admissions to hospital of ≥ 72 hours duration.  It is now used alongside CFS for all patients admitted to our Complex Frailty Unit, identifying patients most likely to benefit from inpatient ACP on discharge.