1. Developing an electronic SPICT TM alert
SPICT TM International Conference University of Edinburgh 2nd February 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

2. 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

3. 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

4. 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

5. 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

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

7. Alerts uploaded by Year and Specialty

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

9. 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

10. 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.

11. CASTLE Register EPaCCS
Up-to-date information available 24/ 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

12. 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?

13. 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

14. 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