Background There has been growing recognition that patients with the symptoms of breathlessness frequently attend the Emergency Department (ED) as they progress towards the end of life. This may represent a cohort of patients who have un-identified and unmet palliative care needs. We investigated whether the SPICT could identify these patients during an acute attendance to the ED.
Methods Retrospective data collection from electronic records on patients who attended ED in December 2018 aged over 65 and had ‘breathless’ equivalent in their triage. A data collection tool was created in Excel. Patient demographics, number of previous admission in the preceding 2 years, presenting complaint were collected, and then assessed against SPICT. Data on the same patients was then collected until December 2019 on further admissions, attendances and mortality. They were then re-scored against the SPICT.
Results A total of 2767 attendances in December met the criteria. The first 2 days of December were analysed. Data was collected on 16 patients. Of these, 7 patients met the SPICT criteria. In 70% admission was due to exacerbation of chronic disease. 1 year later 5 patients were still alive. On re-assessment only 4 out of 7 met the SPICT criteria. Patients who met the SPICT had a mean number of attendances to ED of 5.4, compared to 3.8. Both patients who died met the SPICT criteria.
Conclusions Our data suggests that the SPICT cannot be applied retrospectively or electronically to identify patients in the acute setting who would benefit from specialist palliative care input. Trends were that patients who did meet the SPICT had a greater number of attendances to ED. Limitations include small sample size, and reliance on correct data entry at the time of attendance. We suggest further data needs to be collected to create a tool specific to ED.
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