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