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1 Evaluation of a nurse directed beds model of care in a stand-alone hospice inpatient unit (IPU)
  1. Charlotte Brigden,
  2. Andrew Thorns,
  3. Wendy Hills and
  4. Amanda Timms
  1. Pilgrims Hospices in East Kent, UK


Introduction Patient complexity needs to be understood to match resources to need in palliative care (Pask et al. 2018). A future increase in need for these services means alternative models of care should be considered (Etkind et al. 2017). Pilgrims Hospice is unique in having three IPUs run by a single organisation covering a distinct geographical area. This set up enabled the implementation of a stand-alone nurse directed unit taking less medically complex patients alongside traditionally staffed IPUs.

Aims The project aimed to answer the following:

  • Can we identify medical complexity prior to admission?

  • Do nurse directed beds in a stand–alone unit improve use of resources produce similar outcome and satisfaction.

Methods Data were collected from routine activity figures surveys of staff and service users’ thematic analysis of operational meetings and a focus group of staff at a strategic level. Tools were utilised to measure complexity and level of need (Gannon 2017).

Results The findings supported using resources more efficiently and for the nursing team to be empowered and developed.

Concerns related to:

  • Travel time when patients not admitted to the closest unit.

  • Inefficient use of beds

  • A perceived need for a full multidisciplinary team including medicine

  • Delay in death certificate completion

  • The medical complexity tool appeared unreliable as a triage tool

Conclusions The concept received support from participants. However we were unable to effectively answer the questions posed for a mixture of system data collection and methodological reasons. For nurse directed beds to be successful a different approach is required.


  1. . Pask S, Pinto C, Bristowe K, van Vliet L, Nicholson C, Evans C, George R, Bailey K, Davies J, Guo P, Daveson B, Higginson IJ, Murtagh FEM. A framework for complexity in palliative care: A qualitative study with patients family carers and professionals. Palliative Medicine2018;32(6):1078–1090.

  2. . Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ. How many people will need palliative care in 2040? Past trends future projections and implications for services. BMC Medicine2017;15:102. Available at

  3. . Gannon C. P-82 what level of medical input do hospice inpatients need and does this correspond to their need for specialist nursing input? A service evaluation in a UK hospice. BMJ Supportive and Palliative Care2017;7(Suppl 1). Available at (Accessed: 25 May 2018)

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