Background The Community Nurse Specialist (CNS) team are responsible for vetting and triaging for all community services - the bulk of total hospice referrals. Prior to this project the process for this involved one member of the CNS team reviewing the referral and acquiring further information from electronic records, referrers and patients themselves to determine which service is appropriate. In addition to this, they assessed the urgency of clinical need. The CNS team felt the process could be more efficient and equitable and change was required.

Aims

1. 100% of referrals to community will be processed within two working days to ensure patients are directed to the right service ensuring the right care in a timely manner.

2. 100% of patients accepted to the service are assessed in a timely manner depending on triage urgency and our agreed targets.

3. To improve the efficiency of and standardise the vetting and triage meeting.

Method Introduction of formal team meeting to encourage collaborative working and shared decision-making on the appropriateness of referrals and which service they should be triaged to.

Introduction of RUN-PC Triage Tool – systematic evidence-based approach in assessment of referrals to make CNS services more equitable for our patients.

Results 100% of referrals to be processed within two working days - 100% achieved. 100% of patients referred to community are assessed in a timely manner depending on triage urgency - 100% of deadlines met. Qualitative feedback via community team questionnaires mostly positive - felt overall better team working but referral forms needed to be improved.

Conclusion Overall we achieved the aims set out but acknowledged ongoing improvement required and identified steps going forward including the need for a hospice multidisciplinary access team; a single point of contact for all clinical services and changes to our hospice referral form.