Background Referrals to the community team are increasing and demand for community palliative care services has led to a longer community waiting list. Consequently, the hospice is struggling to respond quickly to referrals for community assessment. In 2016/2017, 200 patients died whilst waiting to be seen.

Aims To reduce the time from referral to initial palliative care assessment for patients who have un-managed symptoms at the point of referral. To reduce the number of patients who die before being seen by specialist palliative care. To reduce unnecessary emergency hospital admissions. To support earlier discharge from hospital. To facilitate appropriate hospice IPU admissions in a timelier manner. To reduce the need to contact the GP or district nurse (DN). To reduce on-going distress of the patient/family member/carer. To create a positive experience for the patient/family member/carer.

Methods The new way of working involved creating capacity in order that a Clinical Nurse Specialist was able to respond in a timely way to patients who have been deemed to need an urgent response due to un-managed symptoms or an expected short prognosis. The urgent response role was intended to have minimal caseload responsibilities, having the capacity to be responsive.

Results The project data extracted was in three phases: (1). 12 weeks pre-project; (2). 12 weeks with an additional 1.0 WTE working as an urgent response nurse; (3). 12 weeks without additional capacity having a substantive CNS working in an urgent response way. The results showed that the different way of working increased the number of assessments completed and the numbers of patients that died before being seen reduced considerably, whilst increasing the number of active patients on caseloads. The project produced positive data that working in a different way could improve responsiveness, but additional capacity improved outcomes even further.