scholarly journals Home or away: which patients are suitable for a psychiatric home treatment service?

2001 ◽  
Vol 25 (8) ◽  
pp. 310-313 ◽  
Author(s):  
Judy Harrison ◽  
Nooreen Alam ◽  
John Marshall
Keyword(s):  
Patient Care ◽  
Information Sources ◽  
Bipolar Affective Disorder ◽  
Home Treatment ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Treatment Service ◽  
Out Of Hours ◽  
Staffing Levels ◽  
Treatment Services

Aims and MethodHome treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.ResultsForty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.Clinical ImplicationsStaffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.

scholarly journals Joint assessment out of hours: assessing the benefits for patients and junior doctors

2013 ◽  
Vol 37 (8) ◽  
pp. 272-275
Author(s):  
Laura Boyd ◽  
Colin Crawford ◽  
Eugene Wong
Keyword(s):  
Mental Health ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Assessment Protocol ◽  
Admission Rates ◽  
Mental Health Nurse ◽  
Health Nurse ◽  
The Impact ◽  
Joint Assessment

Aims and methodWe examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.ResultsIn the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.Clinical implicationsJoint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.

scholarly journals The EWTD: friend or foe to quality patient care?

2006 ◽  
Vol 88 (9) ◽  
pp. 318-319
Author(s):  
MBS Brewster ◽  
R Potter ◽  
D Power ◽  
V Rajaratnam ◽  
PB Pynsent
Keyword(s):  
Patient Care ◽  
Medical Staff ◽  
Junior Doctor ◽  
European Working Time Directive ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Quality Patient Care ◽  
European Working ◽  
The Uk ◽  
Working Time Directive

For the last few years all the hospitals in the UK have been changing junior doctors' rotas to become compliant with the European Working Time Directive (EWTD). The first stage, requiring a junior doctor to work a maximum of 58 hours per week averaged over a 6-month period, became law in August 2004. In addition to new posts for junior doctors there have been schemes to facilitate the transition, such as the Hospital at Night programme. This was designed to use the minimum safe number of doctors from appropriate specialties with supporting medical staff to cover the hospital out of hours. It was required to make the most efficient use of this team and allow the junior doctor rotas to be compliant with the appointment of as few new posts as possible.

scholarly journals Outcome of acute psychiatric in-patient care where there are no crisis or home treatment teams

2007 ◽  
Vol 31 (10) ◽  
pp. 387-390
Author(s):  
Polash Shajahan ◽  
Mark Taylor
Keyword(s):  
General Practice ◽  
Service Delivery ◽  
Patient Care ◽  
Home Treatment ◽  
Clinical Implications ◽  
Valuable Resource ◽  
Admission Rates ◽  
Accident And Emergency ◽  
Routine Monitoring

Aims and MethodTo examine the pathways and outcomes of in-patient care in our locality before crisis teams were introduced details of all emergency referrals to psychiatry were recorded and all admissions to hospital were assessed within 24 h of admission and discharge.ResultsOver a 6-month period, 88% (n=1852) of calls to the duty psychiatrist occurred between 09.00 and 01.00 h. Referrals from accident and emergency and general practice represented the majority of calls (80%); 40% of patients were admitted. Highest admission rates were for patients who were psychotic, suicidal or depressed. Admission led to improvement in all symptoms.Clinical ImplicationsIn-patient care is a valuable resource for stabilising patients who are acutely ill. Routine monitoring of unscheduled activity can inform service delivery.

scholarly journals Does a limited nurse triage service reduce junior doctor psychiatric on-call workload?

2004 ◽  
Vol 28 (10) ◽  
pp. 368-370 ◽  
Author(s):  
A. P. Moore ◽  
S. Willmott
Keyword(s):  
Seasonal Variations ◽  
Junior Doctor ◽  
Average Length ◽  
Time Frame ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Adult Psychiatry ◽  
Night Shifts ◽  
Nurse Triage

Aims and MethodTo investigate whether nurse triage might reduce junior doctors' on-call workloads in a general adult psychiatry in-patient unit, we measured changes in workload after the introduction of a limited (overnight and weekend mornings) nurse triage service on the unit, comparing pre-triage work levels with levels 1 year later. This time frame allowed the new service to settle in, and controlled for seasonal variations in workload.ResultsThe number of ‘work episodes' went up, especially during the night shifts, but the average length of each episode went down (both statistically significant, P < 0.001). The net result was a slight increase in workload in terms of total time spent dealing with episodes, most notably at night.Clinical ImplicationsA limited overnight nurse triage service was ineffective on its own as a means of reducing the out-of-hours workload of junior doctors, and even slightly increased it. A more comprehensive triage service, with a greater range of alternatives to admission, might have had a different result.

Home treatment for acute mental healthcare: randomised controlled trial

2019 ◽  
Vol 216 (6) ◽  
pp. 323-330 ◽  
Author(s):  
Niklaus Stulz ◽  
Lea Wyder ◽  
Lienhard Maeck ◽  
Matthias Hilpert ◽  
Helmut Lerzer ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Care ◽  
Home Treatment ◽  
Social Outcomes ◽  
Control Group ◽  
Treatment Alternative ◽  
Service Model ◽  
Treatment Services ◽  
Hospital Days ◽  
Hospital Use

BackgroundHome treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment.AimsTo test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use.MethodA total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2–F6, F8–F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437).ResultsThe mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242).ConclusionsHome treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.

scholarly journals Implementation of crisis resolution/home treatment teams in England: national survey 2005–2006

2008 ◽  
Vol 32 (10) ◽  
pp. 374-377 ◽  
Author(s):  
Steve Onyett ◽  
Karen Linde ◽  
Gyles Glover ◽  
Siobhan Floyd ◽  
Steven Bradley ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Online Survey ◽  
Home Treatment ◽  
Clinical Implications ◽  
Successful Implementation ◽  
Crisis Resolution ◽  
Out Of Hours ◽  
Face To Face ◽  
Gate Keeping ◽  
Made In

Aims and MethodTo describe implementation of crisis resolution/home treatment (CRHT) teams in England, examine obstacles to implementation and priorities for development. We conducted an online survey followed by a telephone or face-to-face interview among 243 teams.ResultsConsiderable progress has been made in implementation with a subset of teams demonstrating strong fidelity to the Department of Health's guidance, particularly in urban settings. However, only 40% of teams described themselves as fully established. Many teams reported a high assessment load, understaffing, limited multidisciplinary input and patchy fulfilment of their gate-keeping role.Clinical ImplicationsSuccessful implementation of the CRHT teams as alternatives to hospital admission requires resources for home treatment out of hours, effective systems working among local services, stronger local understanding and advocacy of the teams' role.

scholarly journals Role of the duty psychiatrist

1992 ◽  
Vol 16 (4) ◽  
pp. 218-219 ◽  
Author(s):  
Judith E. Nicholls
Keyword(s):  
Hospital Admission ◽  
Patient Care ◽  
Psychiatric Illness ◽  
Home Treatment ◽  
Psychiatric Services ◽  
Living Alone ◽  
Treatment Service ◽  
Physical Problems ◽  
At Home

Recent changes in psychiatric services have produced a movement away from large hospitals to management within the community. A successful home treatment service with 24-hour cover has been described for severe acute psychiatric illness, though hospital admission was not entirely avoided (Dean et al, 1990). It is difficult to manage violent patients or those who will not comply with medication at home. If relatives are not supportive hospital admission will be required. Although living alone is not a contraindication to treatment at home, those who require constant supervision because they are, for example, suicidal need to be admitted. Concurrent physical problems may also necessitate hospital admission. Any future services must therefore include some in-patient care.

scholarly journals Home treatment in Bradford

1999 ◽  
Vol 23 (6) ◽  
pp. 349-352 ◽  
Author(s):  
Patrick Bracken ◽  
Bruce Cohen
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Home Treatment ◽  
Clinical Implications ◽  
Treatment Service ◽  
Unstable Housing ◽  
Medical Environment ◽  
The City ◽  
At Home

Aims and methodWe describe a new home treatment service established In one sector of the city of Bradford.ResultsThere was a tendency for the patients hospitalised from this sector to have more unstable housing backgrounds. It was found that a higher percentage of patients with diagnoses of serious mental Illness were cared for at home.Clinical implicationsWe argue that even in the presence of home treatment, there Is a continuing need for asylum. However, we make the case that this does not always have to be provided In a medical environment.

scholarly journals Situational analysis of diabetic retinopathy treatment Services in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Agatha Mensah-Debrah ◽  
Kwesi Nyan Amissah Arthur ◽  
David Ben Kumah ◽  
Kwadwo Owusu Akuffo ◽  
Isaiah Osei Duah ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Vitreoretinal Surgery ◽  
Health Facilities ◽  
Service Utilisation ◽  
Eye Care ◽  
Treatment Service ◽  
Treatment Services ◽  
Disadvantaged Population ◽  
Anti Vegf ◽  
Geographical Regions

Abstract Background Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment. Methods A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities. Results Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye. Conclusion Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage.

Sign in / Sign up

Export Citation Format

Share Document