PPT34 Evaluating the recognition of dying and referral to palliative care services at East Sussex healthcare trust (ESHT)

<h3>Background</h3> National Audit of Care at the End-of-Life data suggests recognition of dying within ESHT acute hospitals occurs, on average, later than the national average. Consequently, some patients on the Last Days of Life Care Plan may not be reviewed by the Supportive and Palliative Care Team (SPCT), despite trust policy expectations. This audit aimed to evaluate timeliness of dying recognition, assess SPCT involvement, and identify barriers to referral with a view to improving practice. <h3>Method</h3> A retrospective review was undertaken of all adult deaths across ESHT during November 2024 excluding suicides, obstetric and paediatric deaths, and out-of-hospital cardiac arrests. Medical records were analysed to assess time from recognition of dying to death, SPCT involvement, reasons for non-referral, and Critical Care Outreach Team (CCOT) reviews. <h3>Results</h3> Dying was recognised in 80% (126/158) of patient deaths, with a mean interval of 1.7 days before death. The SPCT reviewed 45% (70/158) of all deaths and 56% (70/126) of those recognised as dying. Patients were recognised as dying but not seen by the SPCT (44%, 56/126) mainly due to lack of referral (79%, 44/56) or death before review (20%, 11/56). Notably, 82% (36/44) of those not referred to SPCT died within 1 day of recognising dying. 7% (3/44) of patients recognised as dying were not referred because additional treatment was being trialled first. CCOT reviewed 6% (10/158) of patients, of which 20% (2/10) were referred to SPCT and 60% (6/10) were not recognised as dying. <h3>Conclusion</h3> Timely recognition of dying is essential to allow SPCTs to address patients’ holistic needs at the end of their life. This evaluation highlights the need for enhanced clinician education and timely decision-making in recognising when a patient is dying and managing accompanying clinical uncertainty. ESHT is implementing Senior Decision Maker training to promote effective earlier SPCT involvement.