It has been a rewarding undertaking to improve the care of dying patients, but one which has taken time and has required consistent management of change to promote the positive outcomes.

This article reports on the implementation process and preliminary results of a year-long pilot project providing hospice day care to patients with non-malignant conditions in Dundee, Scotland, UK. With appropriate enthusiasm, planning, consultation, staff education, access via clinical nurse specialist screening, careful referral criteria, goal-setting, an overt discharge policy and close collaboration between clinical nurse specialists, specialist palliative care services and the primary health care team, we were able to offer care to a small number of selected patients perceived to have the greatest need. This model could be applied in other regions. Twenty-eight patients out of a possible 52 who fitted referral criteria attended day care during the year, 16 were discharged and four patients died. Attendance appeared generally acceptable to patients. The project did not overwhelm the service, had negligible impact upon inpatient admissions and did not require extra funding.

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