Background With the steady rise of annual deaths, increased patient complexity, and ongoing financial constraints there is a threat to how hospices can continue to deliver the excellent care they are renowned for. As hospices adopt working models to cope with these ever increasing challenges it is imperative that services are delivered in a timely manner. To best achieve this, hospices need to examine their patterns of patient input and the level of care that is delivered throughout a patient’s journey. A way of balancing demand would involve hospices being more proactive in discharging patients when stable. With the development of the Rehabilitative Palliative Care model and the suite of OACC measures, hospices are now in a position to utilise this approach.

Aim To explore how to facilitate discharging patients from hospice services appropriately without impacting on care.

Methods Systematic literature review and qualitative study using a patient focus group.

Results Evidence shows that facilitating appropriate access to hospice services requires understanding of staff and patient behaviours. Findings show hospice staff often provide a ‘total care’ approach leading to increased patient dependency and are uncomfortable with the notion of discharging patients. Although research is limited, early findings suggest patients develop a complex bond with their hospice and view it as a place that fills the void and gives meaning to their life. This creates practical and ethical barriers to discharging patients, especially when there is unlikely another service that matches hospice care.

Conclusions Ongoing research is needed but there is the recognition that discharging hospice patients is a sensitive topic and raises concerns how this can be managed and perceived. However, there are strategies that can be implemented to aid this and given the current and ongoing challenges hospices face is this a conversation we can no longer avoid?