Background Thames Hospice IPU is a 28-bedded unit providing specialist palliative care to East Berkshire and South Buckinghamshire. With very high demand for inpatient beds, we identified scope to improve the admissions process.

Methods QI methodology was used to implement and evaluate changes to the IPU admissions process. In cycle 1 a dedicated afternoon admissions meeting was introduced, with attendance of key hospice staff. In cycle 2, the hospice referral form was adapted to be more user-friendly and to better inform admissions decisions.

The changes were evaluated by collecting qualitative and quantitative data, including:

• Time between referral received and bed offered, T(referred-offered)

• Time between referral received and patient admitted, T(referred-admitted)

• Referrers’ perceptions of accessibility, timeliness, and satisfaction

• IPU staff’s perceptions of accessibility of information, process efficiency, and overall satisfaction

Results Average T(referred-offered) reduced by 30.3 hours in cycle 1 (n=28 pre-intervention, n=22 post-intervention, p=0.045), and 41.6 hours in cycle 2 (n=15 pre-intervention, n=12 post-intervention, p=0.104).

Average T(referred-admitted) also fell by 29.5 hours and 40.1 hours in cycles 1 and 2 respectively.

Referrers’ perception of timeliness of admissions improved. 72.7% of respondents expressed a wish to continue with the new admissions meeting structure after cycle 1, with nobody wishing to revert to the previous structure.

Satisfaction of IPU staff improved across both cycles, with 100% of respondents reporting that changes made in cycle 1 were positive, and staff also reporting increased efficiency following cycle 2 (42% respondents reported processes very efficient cf. 22% at start of QI project).

Conclusions This QI project involving simple changes to the Thames Hospice IPU admissions process has shown significantly improved staff satisfaction and admission efficiency (i.e. reduced time from referral to admission), therefore improving quality of care for TH patients and ability to access IPU services.