Aims To determine whether the introduction of refined referral limitations, including daily triage, influenced the nature of the response visits undertaken by the community ‘Hospice at Home’ team, with particular attention being paid to the type of care requested and provided and the condition of the patient.

Methods The research was conducted in the form of a thematic analysis (see Braun & Clarke, 2006; Seal, 2016) using the community clinical records which documented the community service response visits. A sample of three groups was selected from patients who had requested and received response visits in June, September and December of 2016, with June acting as the pre-change control group. The encounter records were then fed through a predetermined coding matrix, focusing upon the source of the request, the reason for the request, the condition in which the attended patient was found to be in, the emotional state of the family or carers and the actions undertaken.

Results It was found that while the introduction of refined referral parameters and daily triage meetings did not influence the need for supplementary tasks, such as personal care or psychological support for the patient or family/carers, or the documented levels of distress amongst family or carers, several transitional themes became apparent. Increased restrictions to referral acceptance amplified the ratio presence of patients who were at the very end of life, with activities subsequently becoming much more focused upon those associated with end of life care and reducing the presence of actions less associated with palliative conditions.

Conclusions The evidence compiled suggests that, whilst more refined referral criteria may at first assessment risk a detrimental impact upon response visits in the community, greater control over the referral process helps with prioritisation and improves responsiveness towards patients with more urgent palliative needs.