17 Optimising palliative care assessment: a quality improvement project on IPOS integration during hospice admissions

Background The Integrated Palliative care Outcome Scale (IPOS) is an important tool for patient care in the palliative setting. Consistent evidence shows that it facilitates comprehensive assessment, improves symptom management, and fosters a patient-centred approach. This quality improvement project aimed to improve the use of IPOS by the medical team for inpatient admissions. Methods We initiated our project with an online survey to identify barriers and understand current practices related to IPOS. This was followed by an educational session explaining the rationale and evidence supporting the use of IPOS. Subsequently, we developed an SOP, complemented by a flowchart, outlining the process of integrating IPOS into the standard admission routine. We also streamlined the process of obtaining the IPOS forms. Outcome measures included the percentage of fully completed IPOS forms, time to completion, and overall IPOS use on admission. Results Pre-intervention, only 15.4% of IPOS forms were fully completed. This figure more than doubled to 34.2% during the intervention, and rose further to 37.2% in the subsequent three months post-intervention. The average time to complete IPOS forms reduced notably: from an average of 5.9 hours pre-intervention, it decreased to 2.25 hours during the intervention and came down to 0.9 hour post-intervention. While the overall use of IPOS surged during our intervention – jumping from 41.4% to 65.9% – it returned to 42.0% after our intervention phase concluded. Conclusion Our project highlighted the impact of targeted strategies in enhancing IPOS use. Through education and streamlined processes, we observed sustained improvements in fully completed IPOS rates and time to completion. However, the post-intervention decline in overall IPOS use indicates the need for continuous reinforcement. Embedding the strategies within routine hospice operations, such as integrating the SOP in the induction of new doctors, may prove helpful