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This is another valuable study using the Scottish public health datasets. It confirms an unplanned hospital admission as an important indicator of deteriorating health that should prompt a review of the patient's overall health and plan of care. Such admissions are key triggers to help identify people whose declining health might otherwise have not been recognised. In our validation study of the SPICT (Supportive and Palliative Care Indicators Tool) in a Scottish acute hospital, unplanned admission was a frequent general indicator.
We would like to clarify that the Surprise Question is not part of the SPICT tool although some people use both tools. In Scotland, we have now adopted anticipatory care planning as a broader, person-held approach to future care planning and are increasingly moving away from the ‘prognostic paralysis’ associated with considering people for an integrated ‘palliative care approach’ only once they are thought to be in the last year of life.
Scottish Anticipatory Care Planning Programme: https://ihub.scot/anticipatory-care-planning-toolkit/
Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. (Development & evaluation of SPICT) BMJ Support Palliat Care Published Online First: 25 July 2013 doi:10.1136/bmjspcare-2013-000488.