Background Evidence suggests that the needs of palliative care service users are changing (van Langen-Datta, Driscoll, Fleming, et al. Compromised connections: The impact and implications of COVID-19 on hospice care in the West Midlands and nationally. 2022). The COVID-19 pandemic has seen many hospices reduce their inpatient capacity and find innovative ways of using telehealth to manage palliative patients in the community (Etkind, Bone, Lovell, et al. J Pain Symptom Manage. 2020; 60(1): e31-e40). We re-designed our hospice inpatient unit space to reflect these changing needs.

Aims Our aims were to re-design our hospice inpatient unit (IPU) to improve palliative care services for both hospice inpatients and those in the community.

Methods We took a multi-professional innovative approach to reviewing how leadership re-structure and integration of teams could help us to re-design our hospice inpatient unit by:

1. Developing a flexible staffing model in which the nurse manager oversees both IPU and day services, promoting an integration of these services. An increased number of Band 6 roles were created to promote nurse-led services within the IPU and to provide senior support for junior staff across all shifts.

2. Reducing admissions by offering medical or nurse-led outpatient clinics for patients requiring symptom management and ambulatory services, for example paracentesis or blood transfusion.

3. Re-designing our IPU space to incorporate day patient beds, a nurse-led clinic room, paracentesis room, family area, children’s bereavement room and research hub.

Results The results have been positive for both patients and staff, and space is being well utilised. Patients are experiencing a more streamlined flow of care through hospice services and can access treatment as a day case, outpatient or experience a shorter admission. Nursing staff have reported feeling more valued and recognised in their specialist roles which has led to staff career progression, leading to increased retention and recruitment.

Conclusions By re-imagining services within the hospice space, and up-skilling staff, we believe that patients have quicker access to palliative care services and inappropriate IPU admissions are prevented.