scholarly journals Long-term impact of the expansion of a hospital liaison psychiatry service on patient care and costs following emergency department attendances for self-harm

BJPsych Open ◽  
2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Joni Jackson ◽  
Manjula D. Nugawela ◽  
Frank De Vocht ◽  
Paul Moran ◽  
William Hollingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Waiting Times ◽  
Credible Interval ◽  
Psychosocial Assessment ◽  
Royal Infirmary ◽  
Liaison Psychiatry ◽  
Self Harm ◽  
Long Term Impact

Background In September 2014, as part of a national initiative to increase access to liaison psychiatry services, the liaison psychiatry services at Bristol Royal Infirmary received new investment of £250 000 per annum, expanding its availability from 40 to 98 h per week. The long-term impact on patient outcomes and costs, of patients presenting to the emergency department with self-harm, is unknown. Aims To assess the long-term impact of the investment on patient care outcomes and costs, of patients presenting to the emergency department with self-harm. Method Monthly data for all self-harm emergency department attendances between 1 September 2011 and 30 September 2017 was modelled using Bayesian structural time series to estimate expected outcomes in the absence of expanded operating hours (the counterfactual). The difference between the observed and expected trends for each outcome were interpreted as the effects of the investment. Results Over the 3 years after service expansion, the mean number of self-harm attendances increased 13%. Median waiting time from arrival to psychosocial assessment was 2 h shorter (18.6% decrease, 95% Bayesian credible interval (BCI) −30.2% to −2.8%), there were 45 more referrals to other agencies (86.1% increase, 95% BCI 60.6% to 110.9%) and a small increase in the number of psychosocial assessments (11.7% increase, 95% BCI −3.4% to 28.5%) per month. Monthly mean net hospital costs were £34 more per episode (5.3% increase, 95% BCI −11.6% to 25.5%). Conclusions Despite annual increases in emergency department attendances, investment was associated with reduced waiting times for psychosocial assessment and more referrals to other agencies, with only a small increase in cost per episode.

scholarly journals Long-term hospital attendance of children and adults who have undergone removal of normal or inflamed appendices

2002 ◽  
Vol 181 (6) ◽  
pp. 526-530 ◽  
Author(s):  
Nicola J. Dummett ◽  
Nicola J. Maughan ◽  
Anne Worrall-Davies
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Attendance Rates ◽  
Liaison Psychiatry ◽  
Abdominal Symptoms ◽  
Secondary Health Care ◽  
Care Systems ◽  
Self Harm ◽  
Males And Females

BackgroundEarly studies suggested that presentations with unexplained acute abdominal pain were associated with increased long-term rates of hospital attendance and self-harm, especially in women, but few studies were large enough for definitive findings.AimsTo test the hypothesis that such presentations are followed by higher long-term utilisation rates of secondary health care even excluding further abdominal symptoms, and particularly for self-harm, than presentations with acute appendicitis.MethodNew hospital attendance rates, liaison psychiatry attendances and self-harm attendances of patients with normal appendices at emergency appendicectomy were compared with those of appendicitis patients.ResultsAttendance rates of all kinds were significantly higher for normal appendix patients than for appendicitis patients, with equal strengths of finding for males and females.ConclusionsPeople with normal appendices at emergency appendicectomy show higher long-term rates of hospital attendance. This has implications for how these patients are best managed by health care systems.

scholarly journals Compliance with NICE guidelines in the management of self-harm

2010 ◽  
Vol 34 (9) ◽  
pp. 385-389 ◽  
Author(s):  
Diane Mullins ◽  
Siobhan MacHale ◽  
David Cotter
Keyword(s):  
Clinical Excellence ◽  
Psychosocial Assessment ◽  
Standards Of Care ◽  
Liaison Psychiatry ◽  
Single Male ◽  
Nice Guidelines ◽  
Accident And Emergency ◽  
Self Harm ◽  
Male Patients ◽  
Accident And Emergency Department

Aims and methodTo identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.ResultsA total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.Clinical implicationsSingle men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

scholarly journals Increasing psychosocial assessment by introducing a self-harm pathway

2006 ◽  
Vol 30 (5) ◽  
pp. 169-172 ◽  
Author(s):  
Peter Lepping ◽  
Barbara Woodworth ◽  
Lucy Roberts ◽  
Jim Turner
Keyword(s):  
Emergency Department ◽  
The Self ◽  
Psychosocial Assessment ◽  
Clinical Implications ◽  
Protocol Adherence ◽  
Steering Group ◽  
Accident And Emergency ◽  
Before And After ◽  
Self Harm ◽  
Accident And Emergency Department

Aims and MethodTo audit whether the introduction of a self-harm pathway and protocol increases the number of psychosocial assessments. All episodes of self-harm in a defined period during 2002 (n=335) and 2004 (n=390) were reviewed before and after the introduction of a self-harm pathway and protocol. Adherence to the protocol was also investigated.ResultsAfter the introduction of the self-harm pathway and protocol, the proportion of psychosocial assessments requested had risen from 57% (2002) to 85% (2004). The proportion of psychosocial assessments completed had risen from 47% to 70%. Over the 2 years, the overall number of self-harm presentations was reduced by 27%.Clinical ImplicationsThe introduction of a self-harm pathway and protocol through a self-harm steering group is feasible, was well accepted and increased the number of psychosocial assessments after self-harm. It may also contribute to a reduction in the number of overall presentations with self-harm to the accident and emergency department.

scholarly journals Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016906 ◽  
Author(s):  
Brent C Opmeer ◽  
William Hollingworth ◽  
Elsa M R Marques ◽  
Ruta Margelyte ◽  
David Gunnell
Keyword(s):  
Working Hours ◽  
Psychosocial Assessment ◽  
Favourable Effect ◽  
Liaison Psychiatry ◽  
Large Hospital ◽  
Before And After ◽  
Self Harm ◽  
Mean Cost ◽  
The Impact ◽  
Patient Attendance

ObjectivesTo evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm.DesignRetrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data.SettingA large hospital in South West England.SubjectsPatients attending the ED for self-harm.InterventionsExtension of the LPS’ working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investmentMain outcome measuresNumber and characteristics of ED attendances for self-harm. The before and after cohorts were compared in terms of key process measures, including proportion of patients receiving a psychosocial assessment, average length of hospital stay, waiting times for assessment, proportion of patients who self-discharged without an assessment, levels of repeat self-harm attendances and mean cost per patient attendance.Results298 patients attended ED for self-harm on 373 occasions between January and March 2014, and 318 patients attended on 381 occasions between January and March 2015. The proportion of ED attendances where patients received a psychosocial assessment increased from 57% to 68% (p=0.003), median waiting time decreased by 3 hours and 14 min (p=0.017), and the proportion of episodes where patients self-discharged without a psychosocial assessment decreased from 20% to 13% (p=0.022). The mean cost per patient attendance was marginally lower after the intervention (−£84; 95% CI −£254 to £77).ConclusionsThe extended LPS seems to have had a favourable effect on the management and outcomes of self-harm patients. The cost of extending the LPS’ working hours might be partially offset by more efficient assessment and discharge. The impact of the extended LPS on the care of hospitalised patients with mental health problems other than self-harm requires further evaluation.

scholarly journals Psychosocial Assessment in the Emergency Department

Crisis ◽  
2021 ◽  
Author(s):  
Penny Xanthopoulou ◽  
Mary Ryan ◽  
Matthew Lomas ◽  
Rose McCabe
Keyword(s):  
Emergency Department ◽  
Treatment Plan ◽  
Psychosocial Assessment ◽  
Care Plan ◽  
Worth Living ◽  
Therapeutic Communication ◽  
Face To Face ◽  
Therapeutic Interaction ◽  
The Future ◽  
Self Harm

Abstract. Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the “person” and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the “risk” and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living.

scholarly journals ‘Relieved to be seen’—patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044434
Author(s):  
Leah M Quinlivan ◽  
Louise Gorman ◽  
Donna L Littlewood ◽  
Elizabeth Monaghan ◽  
Steven J Barlow ◽  
...  
Keyword(s):  
Mental Health ◽  
Online Survey ◽  
Waiting Times ◽  
Research Process ◽  
Psychosocial Assessment ◽  
Health Staff ◽  
Free Text ◽  
Mental Health Staff ◽  
Inappropriate Use ◽  
Self Harm

ObjectivesWe sought to explore patient and carer experiences of psychosocial assessments following presentations to hospital after self-harm.DesignThematic analysis of free-text responses to an open-ended online survey.SettingBetween March and November 2019, we recruited 88 patients (82% women) and 14 carers aged ≥18 years from 16 English mental health trusts, community organisations, and via social media.ResultsPsychosocial assessments were experienced as helpful on some occasions but harmful on others. Participants felt better, less suicidal and less likely to repeat self-harm after good-quality compassionate and supportive assessments. However, negative experiences during the assessment pathway were common and, in some cases, contributed to greater distress, less engagement and further self-harm. Participants reported receiving negative and stigmatising comments about their injuries. Others reported that they were refused medical care or an anaesthetic. Stigmatising attitudes among some mental health staff centred on preconceived ideas over self-harm as a ‘behavioural issue’, inappropriate use of services and psychiatric diagnosis.ConclusionOur findings highlight important patient experiences that can inform service provision and they demonstrate the value of involving patients/carers throughout the research process. Psychosocial assessments can be beneficial when empathetic and collaborative but less helpful when overly standardised, lacking in compassion and waiting times are unduly long. Patient views are essential to inform practice, particularly given the rapidly changing service context during and after the COVID-19 emergency.

scholarly journals ‘Wasn’t offered one, too poorly to ask for one’ – Reasons why some patients do not receive a psychosocial assessment following self-harm: Qualitative patient and carer survey

2021 ◽  
pp. 000486742110112
Author(s):  
Leah Quinlivan ◽  
Louise Gorman ◽  
Donna L Littlewood ◽  
Elizabeth Monaghan ◽  
Stephen J Barlow ◽  
...  
Keyword(s):  
Suicide Risk ◽  
Alcohol Intoxication ◽  
Waiting Times ◽  
Psychosocial Assessment ◽  
Compassionate Care ◽  
The United Kingdom ◽  
Qualitative Survey ◽  
Self Injury ◽  
Acute Hospitals ◽  
Self Harm

Objective: Psychosocial assessment following self-harm presentations to hospital is an important aspect of care. However, many people attending hospital following self-harm do not receive an assessment. We sought to explore reasons why some patients do not receive a psychosocial assessment following self-harm from the perspective of patients and carers. Methods: Between March and November 2019, we recruited 88 patients and 14 carers aged ⩾18 years from 16 mental health trusts and community organisations in the United Kingdom, via social media, to a co-designed qualitative survey. Thematic analyses were used to interpret the data. Results: Patients’ reasons for refusing an assessment included long waiting times, previous problematic interactions with staff and feeling unsafe when in the emergency department. Two people refused an assessment because they wanted to harm themselves again. Participants reported organisational reasons for non-assessment, including clinicians not offering assessments and exclusion due to alcohol intoxication. Other patients felt they did not reach clinically determined thresholds because of misconceptions over perceived heightened fatality risk with certain self-harm methods (e.g. self-poisoning vs self-cutting). Conclusion: Our results provide important insights into some of the reasons why some people may not receive a psychosocial assessment following self-harm. Parallel assessments, compassionate care and specialist alcohol services in acute hospitals may help reduce the number of people who leave before an assessment. Education may help address erroneous beliefs that self-injury and self-harm repetition are not associated with greatly raised suicide risk.

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