Background There is a national drive to support patients in their preferred place of choice and a need to reduce the number of unnecessary hospital admissions (Department of Health, 2008; National Palliative and End of Life Care Partnership, 2015). The community teams received over 1600 referrals last year. The triage team perform a telephone assessment, prioritising patients on need and transferring them to community clinical nurse specialists (CNSs). There was no formal pathway to respond to urgent needs of new and existing patients. It was unclear where to escalate urgent calls if all CNSs were occupied with planned visits. We decided to introduce a designated daily rapid response CNS into each of the teams to respond to the urgent referrals and reduce the number of patients who died before assessment.

Aims To introduce changes in working practices to respond to patients in a timely manner, with the intention to provide palliative care to more patients at home, thus supporting them in their preferred place of care (Calanzani, Higginson, Gomes, 2013).

Results The role of the rapid response CNS was defined and introduced into the three borough teams – each team identifies a rapid response CNS each day on the off duty. They are the first point of contact for the triage team and community administrators who frequently take calls from patients. The rapid response CNSs minimise planned visits for that day to ensure they have time to respond to urgent patient need.

Conclusion This was a challenge to traditional ways of working (Leary, Crouch, Lezard et al., 2008), however, involving the CNSs in developing the structure of the role and the pathway helped to develop a sense of ownership of the project. Although it is too early to formally evaluate there is a feeling of confidence and security for staff in the knowledge that their responsibilities are clearly defined. For the future we will examine responsiveness by introducing new activity codes to support data collection.