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Introduction Iloprost is a prostacyclin analog that modulates small vessel vasculopathy. The 2024 BSR national guideline for management of SSc recommends the use of intravenous (IV) prostanoids as rescue therapy for severe systemic sclerosis (SSc)-associated Raynaud’s phenomenon.This audit aimed to evaluate the current practice of indication, frequency and duration of IV Iloprost delivery alongside concomitant use of oral vasodilators in a tertiary SSc referral centre.Based on the findings, we aimed to reduce variation of Iloprost delivery by:reducing the frequency and duration of iloprost delivery and,exploring optimisation of using oral vasodilators by implementing a standardised pathwayMaterial and Methods Clinical and demographic data of patients receiving Iloprost in a dedicated day-case unit at a tertiary SSc referral centre in London, UK was collected retrospectively over 6 months (August 2023 - January 2024). This included Iloprost indication, frequency/duration of infusion and concomitant oral vasodilator therapy (including calcium channel antagonists, angiotensin receptor blockers, phosphodiesterase-5 inhibitors and bosentan).Results 169 patients received IV Iloprost over the 6 months audit period, the indication being SSc in 81% and 19% for primary Raynaud’s (PR)/erythromelalgia (EM).The majority (n= 127; 75%) were administered 5-days Iloprost infusions, while 25% received 3- or 4-days infusions. 63% attended for 6 monthly infusions, 17% attended 3 or 4 monthly and 20% annually.Notably, 40/169 (24%) patients are not presently on any oral vasodilators. Optimising oral vasodilator therapy, including Bosentan, for all clinically stable patients could reduce the necessity for frequent hospital visits for Iloprost infusions.Further trials to determine which patients can safely transition to shorter infusion durations or frequencies may allow some 5-day admissions to be reduced, thereby improving patient convenience and decreasing hospital resource usage. It is also crucial to consider patient compliance and willingness to accept a reduced infusion frequency, given potential known side effects of hypotension.Among the 3-monthly infusion attenders, 7 out of 28 patients have PR/EM. A pilot study of nurse-led shorter infusion period over the weekend may be considered for these patients, to provide flexibility, minimise workday disruptions and create more appointment slots for other day case indications.Conclusions This data aligns with the 2024 BSR SSc guideline recommendation of the need for a dedicated day-case unit for Iloprost administration for a specific SSc patient cohort in addition to a severe PR/EM cohort. Optimisation of the Iloprost delivery pathway has potential to enhance better clinical outcomes and ensure more cost-efficiency.