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Improving the care pathway for patients with mental health conditions presenting to the Emergency Department Acknowledgments We would like to thank Dr Savvas Papasavvas (MH Lead, St Thomas’ ED) for all of his invaluable guidance, Runa Da Costa and the Liaison Psychiatry team 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 • Achieving parity of esteem between mental and physical health condiHons is a key priority within the NHS at present • The NCEPOD Treat As One report has idenHfied there is a long way to go before this is achieved within the acute care system (1) • An example of this can be seen in the Emergency Department (ED) at Guy’s and St Thomas’ NHS FoundaHon Trust • The Trust introduced a Mental Health Integrated Care Pathway (MHICP) proforma in 2014 to standardize mental health care in the ED, which includes a Mental State Examina@on (MSE) and management/referral pathways • Despite this implementaHon, MHICP and MSE usage in October 2016 was 27% and 17% respec@vely References 1) The NaHonal ConfidenHal Enquiry into PaHent Outcome and Death. ‘Treat as One’. (2017) London. h.p://www.ncepod.org.uk/2017report1/downloads/ TreatAsOne_FullReport.pdf Aim To improve the documenta@on of Mental State Examina@ons (MSE) and use of the Mental Health Integrated Care Pathway (MHICP) in St Thomas’ Emergency Department to 90% Figure 3: The poster from PDSA Cycle 2, refined to communicate key points Recommenda@ons To achieve parity of esteem in the acute seYng: • MSE/MHICP usage should be re-audited more oVen • The MHICP should be included within the main clerking proforma • There should be beWer ownership of the organiza@on of MH care pathways Results Figure 2: MHICP and MSE usage throughout the project Conclusions • Educa@on and prac@cal changes were successful in improving MSE compleHon rates and MHICP usage, although we did not meet our original target • Part of the remaining deficit appears to be due to a mixture of human and systemic factors • Direct referrals to Liaison Psych from GP’s and Triage • Junior members of ED team more efficient at standardized documentation Method • 2 Plan Do Study Act (PDSA) cycles with audit before and a[er • Cycle 1: • Posters in prominent posiHons throughout department • Educa@on sessions • Reminder messages read out during morning and evening handover • Cycle 2 • Physical copies of the MHICP placed in all Majors drawers • Refined poster • Handover messages and educaHon conHnued • Over the two PDSA cycles MHICP usage improved from 27% to 57%, while MSE comple@on improved from 17% to 47% • The improvement was maintained without acHve intervenHon between cycles • There were 4 runs in the run charts for the MSE and MHICP, indicaHng our intervenHons were effecHve

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Page 1: Improving the care pathway for patients with mental health ... · Improving the care pathway for patients with mental health conditions presenting to the Emergency Department Acknowledgments

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

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