@ncepod #MH 1 Chapter 1 Background & Method Hannah Shotton - PowerPoint PPT Presentation

@ncepod #MH 1

Chapter 1 Background & Method Hannah Shotton 2

Background  A large proportion of people are affected by poor mental health  Link between physical and mental health in general hospitals  Lack of integration between delivery of mental and physical healthcare  Liaison psychiatry services 3

Definitions  General hospitals  Mental health conditions  Liaison psychiatry team  Mental health legislation 4

Aim To explore the overall quality of mental and physical healthcare provided to patients with significant mental health conditions who are admitted to a general hospital. 5

Objectives To explore the provision of organisational structures and policies: 1) Communication and sharing of relevant information 2) Systems, Services and facilities to deliver care to patients with mental health conditions 3) Training

Objectives To explore remediable factors in the overall quality of care provided to this group of patients particularly focusing on the following areas: 1) Referral /review by liaison psychiatry and appropriate management by liaison psychiatry and general hospital staff 2) Communication and record sharing 7

Objectives The assessment of mental capacity and deployment of 3) mental health legislation The management of medications, reconciliation and 4) possible interactions Discharge planning 5) The standard of care and treatment provided 6) Evidence of missed opportunities for intervention 7) 8

Study population Patients aged 18 + admitted to a general hospital for physical healthcare during the study period: – Detained under mental health legislation during their admission to hospital and/or – Coded by ICD10 coding for a diagnosis of a listed mental health condition 9

Method Patients identified Spreadsheet from each hospital participating  Key information on patients who fit the study criteria  5 patients selected per hospital 1 who was admitted to critical care or who died  1 who was admitted from/discharged to a MH hospital  1 who was admitted due to self-harm  2 patients admitted for a stay longer than 72 hours  10

Method  Clinician questionnaire  Liaison psychiatry questionnaire where accessible  Case notes/Case reviewer assessment form  Organisational questionnaire  On-line survey of training 11

Chapter 2 Sample population 12

Data returns 305 Organisational questionnaires disseminated 231 Organisational questionnaires returned 1340 responses to the online survey of training 13

Population 14

Primary medical reason for admission 15

Physical health co-morbidities 16

Mental health conditions in the sample population 17

Chapter 3 Presentation to hospital Vivek Srivastava 18

Presentation to hospital 351/552 (63.6%) via the emergency department  80/552 (14.5%) via a GP referral  19

Mental health conditions recorded in the ED MH condition recorded at triage in 67.6% (200/296) of  patients and at senior review in 84.9% (265/312) of patients 20

Referral made to the liaison psychiatry team 21

Referral to liaison psychiatry Referral made to liaison psychiatry in 55/327 (15.8%) patients  Quality of care affected in 20 patients  22

Reason patient was not referred to liaison psychiatry 23

Arrival of liaison psychiatry in the ED 24

Chapter 4 Admission & initial management 25

Listed medications 26

Medicines reconciliation 27

28

Physical health recorded at initial assessment 29

Mental health recorded at initial assessment 30

Physical health recorded at consultant review 31

Mental health recorded at consultant review 32

Clerking proforma – organisational data 33

Adequate history in nursing notes 34

Impact of consultant review 35

Adequate assessment of complex needs Complex needs assessment undertaken in 171 patients  Inadequate in 34 patients  36

Multidisciplinary care 37

Liaison psychiatry review Sean Cross 38

Components of the liaison psychiatry review 39

Delay in liaison psychiatry review 40

Reason for delay in liaison psychiatry review Delay in liaison psychiatry review in 74/199 (37.2%) patients  41

Sufficient input from liaison psychiatry Delay impacted on the quality of care of 22 patients  Patients seen only once by liaison psychiatry in 135/225 (60%)  42

Patients who were not reviewed by liaison psychiatry but should have been 43

44

Legal frameworks 45

Patient was detained under mental health legislation 34 patients were detained at admission with details documented  in 24 cases 46

47

Personnel assessing mental capacity 48

Reason for assessing mental capacity 49

Room for improvement in mental capacity assessments 50

51

Communication 52

MDT inclusion 53

Liaison psychiatry in the MDT 54

MDT changed the management plan 55

Chapter 5 Ongoing patient care 56

Care refused by the patient Mental health was a contributing factor in 136/149 (91.3%) patients  57

Could have been prevented 58

Multiple incidents in the same patients Room for improvement 59

Chapter 5 Surgery & other interventions Vivek Srivastava 60

Surgery/intervention as a result of a mental health condition Room for improvement in consent in 24/109 (22.0%) cases  reviewed 61

62

Continuity of essential drugs 63

Clinical deterioration 1 patient not admitted to critical care due to their mental  health condition 64

Chapter 6 Outcomes 65

Discharge destination 66

Delay in discharging patients Delay in discharge in 65/443 (14.7%) patients  67

Appropriate risk assessment at discharge 68

Plan for review appointment 69

Information included in the discharge summary 70

71

End of life care Sepsis/infection was the most common cause of death (29/50)  72

Chapter 7 Organisational data Sean Cross 73

Type of hospital 74

Liaison psychiatry service 75

Liaison psychiatry service 76

Liaison psychiatry service 24/7 liaison psychiatry in 94/184 (51.1%) general hospitals  77

Liaison psychiatry service 78

Triggers for referral to the liaison psychiatry service 102/185 hospitals had a policy for who should be referred to  liaison psychiatry 79

Non-clinical activities of the liaison psychiatry service 80

PLAN accreditation 81

Protocols and policies 82

Protocols for physical health and mental health 123/211 (58.3%) hospitals had protocols covering the  treatment of patients with mental health conditions who are admitted for physical health conditions 83

Protocol covering mental capacity 84

Observation and supervision of patients 85

Policy for addictive substance replacement 86

History of smoking status 87

Record keeping 88

Records management 89

Clinical record sharing 90

Discharge summaries copied to community 91

Improvements being made in record sharing 92

Central database for MH legislation requirements 93

Clinical governance Hospitals reported: No joint governance in 124/201 (61.7%)  No shared learning with primary care in 119/194 (61.3%)  No rolling mental healthcare audits in 124/204 (60.8%)  No monitoring of readmissions/outcomes in 131/195 (67.2%)  No monitoring of adverse/ serious incidents in 102/201 (50.7%)  94

Education and training 95

Mental health training 96

Mental health training 97

Mental health training 98

Mental health training 99

Mental health training 100