Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Mudge, Alison; Douglas, Clint; Sansome, Xanthe; Tresillian, Michael; Murray, Steven R.; Finnigan, Simon; Blaber, Cheryl Ruth

doi:10.1136/bmjspcare-2017-001441

Cited by 32 publications

(32 citation statements)

References 25 publications

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“…Effective communication of information is essential to implement patients' choices in end-of-life decisions. 30 The NHS Five year forward view recognises the collaboration and communication between HCPs. 31 To ensure this, emphasis was placed on detailed written documentation and, on occasion, telephone calls to primary care providers.…”

Section: Improve Communication Of Acp Discussion Between Primary Andmentioning

confidence: 99%

Increasing advance care planning in the secondary care setting: A quality improvement project

Steel

Bertfield

2020

Future Healthcare Journal

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Background Advance care plans (ACP) provide patients the opportunity to communicate their goals and wishes for future care. Local problem A retrospective case note review of 50 inpatient deaths in 2017 confirmed a doctor had discussed expected death in 90%, however only 2% had an ACP. Methods Patients appropriate for ACP were identified on a single geriatrics ward. Interventions were implemented with monthly data collection. Patients with an ACP were followed prospectively. The initiatives were subsequently applied across six geriatrics wards. Interventions Interventions included improved identification of patients appropriate for ACP, doctor education and improved communication to general practitioners and healthcare providers. Results Before initiation of interventions on the pilot ward, ACP was completed for 38% of appropriate patients; this increased to a mean of 78.6% over 4 months post-interventions. During the pilot, 44 patients had an ACP. Of those discharged, 75% avoided readmission over the following 6 months. After applying the interventions across all geriatric wards, ACPs increased to a mean of 81.2% and was maintained 12 months later at 72%. Conclusions The initiatives formed a structure to promote the use of ACP on the wards. Care plans focused on individualising care and effective communication resulted in reduction of readmissions.

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Section: Improve Communication Of Acp Discussion Between Primary Andmentioning

confidence: 99%

Increasing advance care planning in the secondary care setting: A quality improvement project

Steel

Bertfield

2020

Future Healthcare Journal

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“…16 conclusIon The CODE framework principles apply across a spectrum of ages and conditions but are most relevant to those with older age (>65 years), life-limiting illness and a 'no' response to the 'surprise question' ('Would I be surprised if this patient died in the next 12 months?'). 17 Code status preference is frequently ignored, misunderstood or improperly documented, which represents a real patient safety issue resulting in preventable harm. Failures in CSDs can result from choice complexity, order entry errors, delayed discussion and lack of formalised training to conduct these difficult conversations.…”

Section: (E) Educate the Workforcementioning

confidence: 99%

CODE: a practical framework for advancing patient-centred code status discussions

2020

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“…As the harms of a false negative result (deny patients palliative care) outweigh the harms of a false positive result (possibly starting palliative care principles too early) [29,30], we value sensitivity more important than specificity. We aim at a sensitivity of more than 70%, a specificity of more than 50% and a AUC of ≥0.70.…”

Section: Goals Of Researchmentioning

confidence: 99%

Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

et al. 2020

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Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward.

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Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study

Abstract: The GSF-PIG approach identified a large minority of hospital inpatients who might benefit from advance care planning. Future studies are needed to investigate the feasibility, cost and impact of screening in hospitals.

Cited by 32 publications

References 25 publications

Increasing advance care planning in the secondary care setting: A quality improvement project

Increasing advance care planning in the secondary care setting: A quality improvement project

CODE: a practical framework for advancing patient-centred code status discussions

Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

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