The problem A hospice inpatient unit was receiving more requests for admission than it could meet. Patients who were felt to need urgent admission would tend to be offered a bed ahead of those whose need was thought to be less urgent. This could result in those with complex moderate intensity symptoms having to wait a considerable time for admission, leading to ongoing suffering and often an escalation in their needs.

The attempted solution A simple scoring system was introduced to assist with prioritisation. Referrers are asked to specify how urgently admission is required (Immediate = within 24 hours, Soon = within 3 days, Routine = within 5 days). Patients are allocated a score for priority of need and then accrue points according to each working day they are on the waiting list. When a bed becomes available, it is allocated to the patient with most points. When several patients have the same number of points and only one bed is available, the team discusses the relative needs of each patient to decide who will be offered the bed.

The outcome Despite training prior to the introduction of the scoring system, there was initially some inconsistency in the way referrers assessed urgency, with a number of patients being listed as “Immediate” inappropriately. Following further discussion and education, this has improved. The system now works well and although demand for beds often still exceeds availability, the system allows them to be allocated in a fair and equitable way and has reduced the time taken to decide which patient (s) will be admitted when there are several on the waiting list. The system has attracted interest from other local hospices who are struggling with the same problem of over demand for beds.