Yes / Occupancy is commonly used to measure bed management in hospices, however increasing complexity of children and young people, and technology dependence mean this is no longer effective. to develop a dependency tool that enables the hospice to safely and effectively manage the use of beds for planned short breaks (respite), preserving capacity for children requiring symptom management and end of life care. Methods: a comprehensive literature review and existing tools were used to inform the development of the Martin House Dependency Tool Framework. Training was provided to staff and the tool piloted before applying it across the hospice caseload. Findings: The Tool has been used on 431 children (=93.1% of caseload). The Tool enabled consistency of assessment and more effective management of resources, owing to a contemporaneous understanding of the clinical needs of those on the caseload. Conclusion: The tool has enabled consistent and transparent assessment of children, improving safety, effectiveness and responsiveness, and the management of the workforce and resources.

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