Introduction The In-patient Unit (IPU) at Prospect Hospice serves a population of 300,000 people and accepts patients for symptom control, terminal care, respite and rehabilitation. Beds are allocated daily on the basis of need. 4 beds have specific criteria attached to them: 2 beds are acute hospital funded and are for hospital transfers, 1 bed is funded by Continuing Health Care and one is for respite admissions. In 2014 an additional sixteenth bed was created.

Methods Following staff consultation, the additional bed was designated a rapid access Bed for Imminently Dying People (RAB). Staff identified that dying people whose preferred place of death (PPOD) was the hospice, were sometimes unable to access beds, because other peoples' symptom control needs were prioritised. This was limiting responsiveness to choice.

Guidance was developed including:

• Admission appropriate if estimated prognosis less than 5 days

• If patient survives less than 5 days they are transferred to one of the other hospice beds to make the RAB available for others

• The bed will remain empty if no appropriate patient identified.

Results

• % RAB occupancy: 42

• Number of patients accessing the bed over 344 days: 48

• Median survival (days): 3

• Minimum stay in hospice (days): 0

• Maximum stay in hospice (days): 51

• % patients who died in hospice: 90

• % patients admitted from community: 44

• % patients admitted from hospital: 56

• Total IPU admissions 2013–14: 357

• Total IPU admissions 2014–15: 405

Discussion The RAB increased responsiveness of the IPU to patient choice regarding PPOD

The RAB has contributed to a significant increase in the number of IPU admissions

Prognostication and thus appropriate bed allocation is accurate for the majority

Staff feedback is positive. Teams in all settings feel better able to respond to patient choice and need.