Background Hospice at Home has continued to grow over the last decade as we have responded to growing demand. To ensure we were able to reach more people in an environment where care in the community is very limited and inequalities exist in accessing specialist palliative care, it was important to examine our practices to ensure efficiency. Prior to implementing changes, we needed to understand where our capacity sat within the service and how we could work differently within the same resource.

Aims The time and motion study aimed to:

• Identify any areas of resource we have within the service.

• Increase our understanding of patient–facing and non patient–facing activity.

• Explore the efficiency of the service.

Methods Phase 1 incorporated the piloting of the data collection tool and two weeks of data collection. Phase 2 included data analysis of both qualitative and quantitative data focusing on:

• Patient contact and intervention.

• Non face–to–face contact time.

• Costs associated with the service.

• Feedback.

Results 153 visits were conducted over a two week period. The main purpose of these visits were to provide end of life care including personal care, emotional support, complementary therapy, moving and handling advice and education for family carers. Results indicated that change was needed in a number of areas including flexibility in staffing, non patient-facing time for clinical staff, and changes to processes including handover and travel to ensure the service offered high quality and cost effectiveness.

Conclusions The time and motion study completed over the two-week period provided us with substantial data and enabled us to identify areas of service improvement. Increasing the number of visits we do as a service in a day, and reducing non patient-facing contact time will enable us to ultimately reach more people.