improving the care pathway for patients with mental health ... · improving the care pathway for...
Post on 29-Oct-2019
2 Views
Preview:
TRANSCRIPT
Improving the care pathway for patients with mental health conditions presenting to the Emergency Department
AcknowledgmentsWewouldliketothankDrSavvasPapasavvas(MHLead,StThomas’ED)forallofhisinvaluableguidance,RunaDaCostaandtheLiaisonPsychiatryteam
Daniel Turk (1), Claire Lloyd (1), Mehul Shah (1), Dr Vivek Srivastava (2)
(1) Guy’s, King’s and St Thomas’ School of Medicine (2) Guy’s & St Thomas’ NHS Foundation Trust
Background• AchievingparityofesteembetweenmentalandphysicalhealthcondiHonsisakeyprioritywithintheNHSatpresent• TheNCEPODTreatAsOnereporthasidenHfiedthereisalongwaytogobeforethisisachievedwithintheacutecaresystem(1)• AnexampleofthiscanbeseenintheEmergencyDepartment(ED)atGuy’sandStThomas’NHSFoundaHonTrust• TheTrustintroducedaMentalHealthIntegratedCarePathway(MHICP)proformain2014tostandardizementalhealthcareintheED,whichincludesaMentalStateExamina@on(MSE)andmanagement/referralpathways• DespitethisimplementaHon,MHICPandMSEusageinOctober2016was27%and17%respec@vely
References1)TheNaHonalConfidenHalEnquiryintoPaHentOutcomeandDeath.
‘TreatasOne’.(2017)London.h.p://www.ncepod.org.uk/2017report1/downloads/TreatAsOne_FullReport.pdf
Aim
Toimprovethedocumenta@onofMentalStateExamina@ons(MSE)anduseoftheMentalHealthIntegratedCarePathway(MHICP)inStThomas’EmergencyDepartmentto90%
Figure3:TheposterfromPDSACycle2,refinedtocommunicatekeypoints
Recommenda@ons
ToachieveparityofesteemintheacuteseYng:• MSE/MHICPusageshouldbere-auditedmoreoVen• TheMHICPshouldbeincludedwithinthemainclerkingproforma• ThereshouldbebeWerownershipoftheorganiza@onofMHcarepathways
Results
Figure2:MHICPandMSEusagethroughouttheproject
Conclusions• Educa@onandprac@calchangesweresuccessfulinimprovingMSEcompleHonratesandMHICPusage,althoughwedidnotmeetouroriginaltarget• Partoftheremainingdeficitappearstobeduetoamixtureofhumanandsystemicfactors
• Direct referrals to Liaison Psych from GP’s and Triage • Junior members of ED team more efficient at standardized
documentation
Method • 2PlanDoStudyAct(PDSA)cycleswithauditbeforeanda[er• Cycle1:
• PostersinprominentposiHonsthroughoutdepartment• Educa@onsessions• Remindermessagesreadoutduringmorningandeveninghandover
• Cycle2• PhysicalcopiesoftheMHICPplacedinallMajorsdrawers• Refinedposter• HandovermessagesandeducaHonconHnued
• OverthetwoPDSAcyclesMHICPusageimprovedfrom27%to57%,whileMSEcomple@onimprovedfrom17%to47%
• TheimprovementwasmaintainedwithoutacHveintervenHonbetweencycles
• Therewere4runsintherunchartsfortheMSEandMHICP,indicaHngourintervenHonswereeffecHve
top related