PPT46 ‘At a critical time’: palliative care involvement in the unwell deteriorating patient in hospital under Martha’s rule

<h3>Background</h3> Martha’s Rule is an NHS patient safety initiative enabling patients and families to request urgent review when there are concerns about clinical deterioration. Following Supportive and Palliative Care Team (SPCT) involvement in several Martha’s Rule cases, a survey was undertaken to evaluate how many patients were already known to SPCT, the clinical outcomes, and whether SPCT referral might have been beneficial for those not previously known. <h3>Methods</h3> A retrospective survey was conducted of all Martha’s Rule cases between April 2024 and March 2025 at East Sussex Healthcare NHS Trust (two acute sites). Data collected included patient demographics, duration on SPCT caseload, and outcomes. For patients not known to SPCT, potential benefit from SPC involvement was assessed based on clinical need and outcome. Patients under 18 years or where the call was unrelated to a clinical issue were excluded. <h3>Results</h3> Twenty-five patients were referred under Martha’s Rule; seven were excluded according to criteria. SPCT were involved in 22% of cases, with a further 39% identified where SPCT input could have been beneficial. Time from invoking Martha’s Rule to SPCT involvement ranged from 0–22 days. At the time of survey (August 2025), 50% of patients had died. Themes identified included concerns about medical care, nursing care, communication, and staff support, particularly where differing team opinions existed. SPCT input included second opinions, conflict resolution, symptom management, and psychological support. <h3>Conclusions</h3> This survey identified missed opportunities for earlier palliative care involvement in Martha’s Rule cases. Earlier SPCT input has the potential to improve communication, support multidisciplinary decision-making, facilitate advance care planning, optimise end-of-life symptom management, and reduce conflict and unnecessary interventions. Next steps include re-surveying following the introduction of clear referral triggers to SPCT, gathering feedback on escalation experiences from families and staff, and incorporating palliative care principles into escalation training.