78 A quality improvement project to improve the referral triage process for a hospice inpatient unit

<h3>Background</h3> Historically, our hospice has had no formal referral triage system. Referrals were discussed verbally, but there was no consistency in the documentation or clarity of how accepted referrals were prioritised. This resulted in miscommunication, discontent amongst referrers and, on occasion, missed referrals. The increasing demand for inpatient hospice beds and their limited availability have underscored the importance of admitting the right patient at the right time. We set out to improve the process of referral discussion documentation, prioritisation and quality of referral information received by standardising the process using the validated RUN- PC tool.¹ <h3>Methods</h3> In November 2023, we identified all referrals made (including those not admitted) to the inpatient unit for that month. For each referral, the iCare (electronic notes system) record was reviewed to assess for any formal documentation of referral triage discussion. In December 2023 a paper-based referral triage form and the RUN-PC tool were introduced and the review repeated. In March, the forms were incorporated on to iCare with repetition of the above process. <h3>Results</h3> At baseline (November 2023), 16% of referrals had a referral triage discussion documented. In December 2023, there was a 23% increase in appropriately documented referrals. By the end of April 2024, 84% of referrals had appropriate triage documentation. In terms of RUNPC, 15% of referrals made between March and April 2024, had a documented score at triage. Of which only two matched the score calculated on admission. <h3>Conclusions</h3> The introduction of the electronic triage form has been an impactful change, leading to standardisation and increased documentation compliance. It has also improved continuity in decision making and clarity for referrers on how we prioritise. Anecdotally it has improved information provided by hospital referrers thereby reducing delays in decision making. We would encourage such standardised approaches to colleagues working in other hospices. <h3>Reference</h3> Russell B, Philip J, Phillips J, Smith A, Collins A, Sundararajan V. Pilot Implementation of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool. <i>J Pain Symptom Manage</i> 2024;<b>67</b>(3):260–268.e2. doi: 10.1016/j.jpainsymman.2023.12.012. Epub 2023 Dec 13. PMID: 38101490.