Developing an electronic SPICT TM alert SPICT TM International Conference University of Edinburgh 2nd February 2018 Dr Sarah MacLaran, Wasim Hussain, Anwar Shaikh, Aumar Tarzi, Paula Yates and Karl O’Sullivan-Smith, UHCW NHS Trust with Dr Claire Magee, Coventry and Warwickshire Partnership NHS Trust

Aim To establish an electronic alert to flag patients who are being managed with a supportive and palliative approach, utilising SPICTTM as objective criteria for identification Encouraging clinical staff who view the clinical record to focus on comfort and quality of life while still considering acute interventions as appropriate to the patient’s personal and clinical needs and preferences

Methods 1 Engagement with local clinical consultants from key specialties managing conditions incorporated within SPICTTM Collaboration with the University of Edinburgh to develop the Coventry and Warwickshire SPICT UHCW NHS Trust ICT Service leads supported development of an electronic form within the Trust’s bespoke clinical database Clinical Results Reporting System (CRRS) CRRS is utilised in UHCW NHS Trust acute hospitals University Hospital Coventry and Rugby Hospital of St Cross and is visible to primary care teams and Myton Hospice staff working in Coventry and Warwickshire

Methods 2 The CRRS Palliative Care SPICTTM Alert identifies patients who fulfil defined objective prognostic criteria are likely to be within the last year of life are being managed with a supportive and palliative approach to care may be carrying an advance care plan Robust clinical governance measures ensure that only senior clinicians who have completed online training can upload a CRRS Palliative Care SPICTTM Alert The online learning module was further revised with the development of the local Electronic Palliative Care Coordination System: EPaCCS known as the "CASTLE Register Care And Support Towards Life’s End

Results The CRRS Palliative Care SPICTTM Alert was implemented in November 2011 Total of 1917 palliative care alerts were uploaded from 3 Nov 2011 to 31 Dec 2017 Alerts uploaded in the last 5 years n = 1729

Total Palliative Care Alerts by Specialty Between 2013 – 2017 n = 1729

Alerts uploaded by Year and Specialty

Deceased patients 1917 total no. alerts from 3 Nov 2011 to 31 Dec 2017 Of these patients with alerts: 1544 have now died: 81%

Advance Care Planning: Patient preferences for future care Months… PROGNOSIS …Days Care in the last days CRRS Palliative Care Alert Advance Care Planning: Patient preferences for future care Palliative Care – hospital and community professionals Electronic Palliative Care Co-ordination System “CASTLE Register” ReSPECT: Recommended Summary Plan for Emergency Care and Treatment

Advance Care Planning The PPC is carried in the “Greensleeve” wallet alongside the ReSPECT wallet The PPC summarises the patient’s personal preferences. The ReSPECT form details their future clinical care. Palliative care patients may also have a CASTLE Register record; the local EPaCCS: Electronic Palliative Care Coordination System.

CASTLE Register EPaCCS Up-to-date information available 24/7 365 days/year across all care settings within office hours and out of hours Care And Support Towards Life’s End Coventry and Warwickshire CASTLE Register EPaCCS

Conclusions The CRRS Palliative Care SPICTTM Alert helps: facilitate appropriate care prompt professionals to offer advance care planning remind hospital staff to liaise with the GP to identify a key worker communicate between primary and secondary care that a patient has supportive and palliative care needs Further evaluation is needed to answer the questions: Did the alert: change patient management? benefit patient care? impact on preferred place of care and death? impact on referrals to specialist palliative care?

Authors Dr Sarah MacLaran, Consultant in Palliative Medicine, UHCW NHS Trust and The Myton Hospices Wasim Hussain, Analyst Programmer, ICT Services, UHCW NHS Trust Anwar Shaikh, Programme Analytics Specialist, Performance and Programme Management Office, UHCW NHS Trust Aumar Tarzi, IT Systems Trainer, UHCW NHS Trust Paula Yates, IT Training Manager, UHCW NHS Trust Karl O’Sullivan-Smith, Head of Development, ICT Services, UHCW NHS Trust Dr Claire Magee, Consultant in Palliative Medicine, Coventry and Warwickshire Partnership NHS Trust

Acknowledgements Palliative care patients of Coventry and Warwickshire Consultant colleagues at UHCW NHS Trust UHCW End of Life Care Committee Champions and users of CRRS Palliative Care Alerts UHCW Macmillan Palliative Care Team UHCW ICT Services Team The Myton Hospices Team