• Gill Highet, Debbie Crawford, Scott A Murray, and Kirsty Boyd.
• Palliative Care Service, Royal Infirmary of Edinburgh, Edinburgh, UK.
• BMJ Support Palliat Care. 2014 Sep 1; 4 (3): 285-90.

ObjectiveTo refine and evaluate a practical, clinical tool to help multidisciplinary teams in the UK and internationally, to identify patients at risk of deteriorating and dying in all care settings.MethodsWe used a participatory research approach to refine the 2010 Supportive and Palliative Care Indicators Tool (SPICT) and evaluate its use in clinical practice. We conducted an ongoing peer review process for 18 months via an open access webpage, and engaged over 30 clinicians from the UK and internationally in developing an effective tool. Secondly, we carried out a prospective case-finding study in an acute hospital in SE Scotland. Four multidisciplinary teams identified 130 patients with advanced kidney, liver, cardiac or lung disease following an unplanned hospital admission.ResultsThe SPICT was refined and updated to consist of readily identifiable, general indicators relevant to patients with any advanced illness, and disease-specific indicators for common advanced conditions. Hospital clinicians used the SPICT to identify patients at risk of deteriorating and dying. Patients who died had significantly more unplanned admissions, persistent symptoms and increased care needs. By 12 months, 62 (48%) of the identified patients had died. 69% of them died in hospital, having spent 22% of their last 6 months there.ConclusionsThe SPICT can support clinical judgment by multidisciplinary teams when identifying patients at risk of deteriorating and dying. It helped identify patients with multiple unmet needs who would benefit from earlier, holistic needs assessment, a review of care goals, and anticipatory care planning.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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