Objective
To evaluate a nurse practitioner (NP)-led extended hours mental health liaison nurse (MHLN) service based in the emergency department (ED) of an inner city teaching hospital in Sydney and to explicate a model of care that is transferable across a broad range of ED settings, both in metropolitan and rural contexts.
Methods
This mixed-methods evaluation encompassed descriptive data on ED mental health presentations, quantifying waiting times for MHLN involvement and interviews with MHLN team members at the commencement of the evaluation and 12 months later. Interviews were also conducted with a snapshot of ED patients, and a sample of ED and psychiatry staff.
Results
The expanded MHLN service was rapidly incorporated into the ED structure, enthusiastically endorsed by ED patients and highly valued by staff and the organisation. The MHLN team saw 55% of referred patients within the first hour of arrival (frequently before medical assessment), thereby initiating and expediting co-ordination of care at an early stage of the ED process.
Conclusions
An NP-led extended hours MHLN team based in the ED provides prompt and effective access to specialised mental health care for people with ‘undifferentiated health problems’, and removes a significant workload from nursing and medical staff. Embedding the NP-led MHLN service within the ED structure was pivotal to the success and sustainability of this model of care.
What is known about the topic?
Mental health liaison nurse (MHLN) services have existed in emergency departments (EDs) in Australia and internationally for many years. However, there is great variation in the way these services are structured and no standardised model of care has been explicated.
What does this paper add?
Findings from this evaluation indicate that a nurse practitioner-led extended hours MHLN service integrated within the ED team structure provides prompt access to specialised mental health care to people with undifferentiated health problems, and removes a significant workload from ED nursing and medical staff.
What are the implications for practitioners?
Mental health nurse-led service provision based in the ED is a safe, flexible and effective method of enhancing access to health care that is adaptable to broad range of settings. ED ownership of this model of care is pivotal to the successful implementation and sustainability of MHLN services.