Psychiatric admissions from crisis resolution teams in Norway: a prospective multicentre study

ObjectiveThe aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DesignCohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SettingInternational (six countries, three continents) multicentre study.Participants281 patients aged ≥70 with operatively treated proximal femur fractures.InterventionsTreatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.Outcome measuresPrimary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.ResultsPatients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).ConclusionsContrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.Trial registration numberClinicalTrials.gov: NCT02297581.

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Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway

BMC Psychiatry ◽

10.1186/s12888-021-03237-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

N. Hasselberg ◽

K. H. Holgersen ◽

G. M. Uverud ◽

J. Siqveland ◽

B. Lloyd-Evans ◽

...

Keyword(s):

Mental Health ◽

Multidisciplinary Teams ◽

Evidence Based ◽

Crisis Resolution ◽

Health Crisis ◽

The Core ◽

Crisis Resolution Teams ◽

Fidelity Scale ◽

The Uk ◽

Evidence Based Model

Abstract Background Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

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‘No service is an island’: experiences of collaboration with crisis resolution teams in Norway

Journal of Interprofessional Care ◽

10.1080/13561820.2021.1888900 ◽

2021 ◽

pp. 1-7

Author(s):

Trude Klevan ◽

Bengt Karlsson ◽

Nina Hasselberg ◽

Torleif Ruud

Keyword(s):

Crisis Resolution ◽

Crisis Resolution Teams

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Screening and identifying hepatobiliary diseases through deep learning using ocular images: a prospective, multicentre study

The Lancet Digital Health ◽

10.1016/s2589-7500(20)30288-0 ◽

2021 ◽

Vol 3 (2) ◽

pp. e88-e97

Author(s):

Wei Xiao ◽

Xi Huang ◽

Jing Hui Wang ◽

Duo Ru Lin ◽

Yi Zhu ◽

...

Keyword(s):

Deep Learning ◽

Multicentre Study ◽

Prospective Multicentre Study ◽

Hepatobiliary Diseases

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Mental health crisis resolution teams and crisis care systems in England: a national survey

BJPsych Bulletin ◽

10.1192/bjb.2018.19 ◽

2018 ◽

Vol 42 (4) ◽

pp. 146-151 ◽

Cited By ~ 3

Author(s):

Brynmor Lloyd-Evans ◽

Danielle Lamb ◽

Joseph Barnby ◽

Michelle Eskinazi ◽

Amelia Turner ◽

...

Keyword(s):

Mental Health ◽

Older Adults ◽

National Survey ◽

Online Survey ◽

Service Improvement ◽

Mental Health Crisis ◽

Crisis Resolution ◽

Health Crisis ◽

Crisis Resolution Teams ◽

Crisis Care

Aims and methodA national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey.ResultsNinety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.Clinical implicationsA national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.Declaration of interestNone.

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