A quality improvement project to reduce the waiting time between referral and service start times in a Scottish hospice.

Background
Appropriate and timely admission to hospice care can result in significant benefits for people living with life limiting disease (Meier, 2011). However, there can be delays in services commencing. Causes for delay may be communication and administrative barriers, restrictions on the days/times when admissions can take place and the non-availability of services (Aldridge Carlson et al, 2012). The Clinical Standards Board for Scotland (CSBS, 2002) recommends that from time of referral to initial contact with specialist palliative care services should be a maximum of two working days. Yet, a national review of palliative care services in Scotland identified a gap in current information on palliative care provision (Clark, 2015).
Aims
Within Ardgowan Hospice, our aim was to improve the referral process to hospice services by identifying barriers and bottlenecks in the referral process.
Methods
Using improvement methodologies, we process mapped the patient journey to identify areas of delays. We then created run charts using existing data to plot current waiting times to explore the variation and medians in wait times for different hospice services. We then used Plan, Do, Study, Act (PDSA) Cycles to test change ideas and record what happened during, and after the test.

Results
Process mapping of referrals to hospice services identified a complex administrative process within the hospice, often leading to inaccurate data collection. Testing change ideas to improve the accuracy of the data collected resulted in the overall median time of referral to service start for hospice services halving from 4 days to 2 days.

Conclusions
Using improvement methodologies within a hospice setting has improved the accuracy of current data collection, thus contributing to the body of knowledge required for the future development of palliative care services in Scotland.