Abstract
Background Hospice inpatient facilities are an important element of the delivery of specialist palliative care. Factors influencing admission to a hospice have received relatively little research attention and are poorly understood. The aim of this study was to describe and explore the judgement and decision making processes that occur in clinical practice when prioritising patients for hospice inpatient admission. A focused ethnographic approach was used to explore the inpatient admission process at six hospice sites in England. Data collection methods included nonparticipant observation of admission meetings at four sites, fifteen interviews with hospice staff and examination of related organisational documentation. The hospice admission process is highly complex and characterised by competing models of care and individual hospices use a variety of admission structures and processes. ‘Doing the right thing’ is presented as the core theme of the hospice admission process. Judgements and decisions related to managing boundary, managing risk and uncertainty and managing face (expectation or reputation). A range of cultural beliefs regarding the appropriate use of the service and individual perspectives on ‘doing the right thing’ were influenced by personal and professional beliefs and models of care, and were specific to the individual role of the professional during the admission process. A lack of consensus and competing models of care regarding the appropriate use of inpatient services, both within hospices and between them was revealed. Factors considered in the decision making process appeared to be, at least, as much focused on protecting the integrity and sustainability of the service as meeting patient need.