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Improving the waiting times within a hospice breathlessness service
  1. Caroline Sime1,
  2. Stuart Milligan2,
  3. Kevin Donal Rooney2,3
  1. 1Institute for Research in Healthcare Policy & Practice, University of the West of Scotland, Hamilton, Scotland
  2. 2School of Health and Life Sciences, University of the West of Scotland, Paisley, Scotland
  3. 3Consultant in Anaesthesia and Intensive Care Medicine, Royal Alexandra Hospital, Paisley, Professor of Care Improvement, University of the West of Scotland, Hamilton, Scotland
  1. Correspondence to Dr Caroline Sime; caroline.sime{at}


Background Breathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.

Aim The aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days.

Methods Using a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources.

Results Using quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.

Conclusions This project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

  • healthcare qouality improvement
  • chronic disease management
  • patient-centred care

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  • Contributors Conception or design of the work was undertaken by all authors (CS, KDR, SM). The quality improvement project was undertaken by CS, and supervised. by SM and KR. Drafting the article was undertaken by CS and critical revision of the paper by KR and SM. Final approval of the version to be published was given by KR.

  • Funding This quality improvement project was jointly funded by Ardgowan Hospice and the University of the West of Scotland.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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