Comparison of liaison psychiatry service models for older patients

Aims and MethodAt a London teaching hospital, the existing off-site consultation model psychiatric liaison service for older people was replaced with an on-site liaison model service in December 2000. Several indicators of the functioning of the service were audited using identical methods before and after this change.ResultsThe case-load increased by 50%, but the liaison psychiatrists were more satisfied with the appropriateness of referrals. The case mix did not change. The new service achieved target waiting times more consistently, particularly for urgent referrals. Referring teams were more satisfied with the speed of response, while the new service maintained the salience and clarity of advice.Clinical ImplicationsFindings are on the whole favourable, and support the wider introduction of specialist old-age liaison psychiatric services.

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Service innovation: an old age liaison psychiatry service

Psychiatric Bulletin ◽

10.1192/pb.bp.106.011460 ◽

2007 ◽

Vol 31 (4) ◽

pp. 145-147 ◽

Cited By ~ 3

Author(s):

Paul Whelan ◽

Kirsten Lawson ◽

Stephen W. Burton

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Old Age ◽

Service Innovation ◽

Mental Healthcare ◽

Liaison Psychiatry ◽

Service Models ◽

Consultation Model

Service models differ for the provision of mental healthcare for elderly medical in-patients. Input by the general adult liaison psychiatry service with no age cutoff (Lipowski, 1983) and sector-based old age community mental health teams (CMHTs) (Scott et al, 1988; De Leo et al, 1989) have been described, as well as a consultation–liaison model. Holmes et al (2003) showed that old age psychiatrists favoured a liaison rather than a consultation model.

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A standard liaison psychiatry service structure?

Psychiatric Bulletin ◽

10.1017/s0955603600003639 ◽

2003 ◽

Vol 27 (12) ◽

pp. 457-460 ◽

Cited By ~ 7

Author(s):

Rachel Ruddy ◽

Allan House

Keyword(s):

General Hospital ◽

Clinical Psychologists ◽

Psychiatric Services ◽

Multidisciplinary Teams ◽

Clinical Implications ◽

Minimum Standard ◽

Liaison Psychiatry ◽

Rational Planning ◽

Health Authorities

Aims and Method We surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served. Results Thirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic. Clinical Implications There is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.

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The clinical utility of the IRAC component of the Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP)

BJPsych Bulletin ◽

10.1192/bjb.2018.29 ◽

2018 ◽

Vol 42 (4) ◽

pp. 152-156

Author(s):

Caroline Guest ◽

Stephen Crockett ◽

Patrick Little ◽

Anish Patel

Keyword(s):

National Health Service ◽

Health Service ◽

Retrospective Analysis ◽

Clinical Utility ◽

Outcome Measurement ◽

Clinical Implications ◽

Referral Process ◽

Liaison Psychiatry ◽

Routine Outcome Measurement ◽

Before And After

Aims and methodThe clinical utility of the multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) has not previously been examined. We sought to establish whether referral accuracy and ability to achieve the reason(s) for referral to our liaison service improved after incorporating the Identify and Rate the Aim of the Contact (IRAC) scale of this tool into our referral process. We carried out a retrospective analysis of electronic case notes of all appropriate referrals to the team before and after this adaption.ResultsAccuracy of referrals to our team improved from 73.8 to 93.7% following intervention. Referral requests that were fully achieved improved from 57.4 to 77.8%, and referral requests that were not achieved decreased from 26.2 to 6.4%.Clinical implicationsThe IRAC component of the FROM-LP measures what it was developed for, and thus has clinical utility supporting its widespread adoption across liaison services in the National Health Service.Declaration of interestNone.

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Relationship between timeliness of contact and length of stay in older and younger patients of a consultation-liaison psychiatry service

BJPsych Bulletin ◽

10.1192/pb.bp.114.047340 ◽

2015 ◽

Vol 39 (3) ◽

pp. 128-133 ◽

Cited By ~ 12

Author(s):

Rebecca Wood ◽

Anne P. F. Wand ◽

Glenn E. Hunt

Keyword(s):

Length Of Stay ◽

Older Patients ◽

Age Groups ◽

Clinical Implications ◽

Liaison Psychiatry ◽

Younger Patients ◽

Lengths Of Stay ◽

Factors Influencing ◽

Consultation Liaison Psychiatry

Aim and methodsThe aims were to determine whether the timeliness of contact with a consultation–liaison psychiatry (CLP) service is associated with shorter lengths of stay (LOS), whether this relationship persists for stays greater than 4 days and whether this association varies with age. The length of stay was correlated with the time from admission to contact with the service (the referral lag (REFLAG)), and the REFLAG's proportion of length of stay (REFLAG/LOS) for all 140 in-patients, those with stays greater than 4 days, and for those under and over 65 years.ResultsThe length of stay was significantly correlated with referral lag and logREFLAG/logLOS for all patients and for patients with stays greater than 4 days. The correlations remained significant for both age groups, but were stronger in the younger group.Clinical implicationsTimeliness of contact with CLP was associated with shorter length of stay, particularly in younger patients. Psychiatric factors influencing length of stay in older patients should be studied by CLP services.

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A standard liaison psychiatry service structure?

Psychiatric Bulletin ◽

10.1192/pb.27.12.457 ◽

2003 ◽

Vol 27 (12) ◽

pp. 457-460 ◽

Cited By ~ 7

Author(s):

Rachel Ruddy ◽

Allan House

Keyword(s):

General Hospital ◽

Clinical Psychologists ◽

Psychiatric Services ◽

Multidisciplinary Teams ◽

Clinical Implications ◽

Minimum Standard ◽

Liaison Psychiatry ◽

Rational Planning ◽

Health Authorities

Aims and MethodWe surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served.ResultsThirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic.Clinical ImplicationsThere is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.

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Droperidol dropped; consultants not consulted

Psychiatric Bulletin ◽

10.1017/s0955603600002786 ◽

2003 ◽

Vol 27 (08) ◽

pp. 301-304

Author(s):

Gavin Reid ◽

Mark Hughson

Keyword(s):

Questionnaire Survey ◽

Clinical Care ◽

Postal Questionnaire ◽

Clinical Implications ◽

The West ◽

Abrupt Withdrawal ◽

Before And After ◽

Adequate Evaluation ◽

Psychiatric Profession ◽

The Impact

Aims and Method We conducted a postal questionnaire survey of the practice of rapid tranquillisation among 215 consultant psychiatrists in the West of Scotland, before and after the withdrawal of droperidol by the manufacturer. Results One hundred and eighty questionnaires (84% of those sent) were returned. Droperidol had been used extensively, often combined with lorazepam, for rapid tranquillisation. The main replacement suggested for droperidol was haloperidol. About half of the respondents to our survey chose to comment on the withdrawal of droperidol. More than half of the comments were unfavourable, including lack of an adequate replacement and lack of consultation with the psychiatric profession. Clinical Implications The abrupt withdrawal of droperidol, partly for commercial reasons, was regrettable. There was no time for an adequate evaluation of possible replacement medications and a lack of consultation with the profession regarding the impact on clinical care.

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Street triage services in England: service models, national provision and the opinions of police

BJPsych Bulletin ◽

10.1192/bjb.2018.62 ◽

2018 ◽

Vol 42 (6) ◽

pp. 253-257 ◽

Cited By ~ 3

Author(s):

Abirami Kirubarajan ◽

Stephen Puntis ◽

Devon Perfect ◽

Marc Tarbit ◽

Mary Buckman ◽

...

Keyword(s):

Mental Health ◽

National Survey ◽

Police Officers ◽

Traditional Approach ◽

Clinical Implications ◽

Modes Of Operation ◽

Specialist Services ◽

Service Models ◽

The Law ◽

Core Part

Aims and methodStreet triage services are increasingly common and part of standard responses to mental health crises in the community, but little is understood about them. We conducted a national survey of mental health trusts to gather detailed information regarding street triage services alongside a survey of Thames Valley police officers to ascertain their views and experiences.ResultsTriage services are available in most areas of the country and are growing in scope. There is wide variation in levels of funding and modes of operation, including hours covered. Police officers from our survey overwhelmingly support such services and would like to see them expanded.Clinical implicationsMental health crises now form a core part of policing and there are compelling reasons for the support of specialist services. Recent changes to the law have heightened this need, with a requirement for specialist input before a Section 136 is enacted. Those who have experienced triage services report it as less stigmatising and traumatic than a traditional approach, but there remains little evidence on which to base decisions.Declaration of interestNone.

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Evaluation of Emergency Health-Care Initiatives to Reduce Overcrowding in a Referral Medical Complex, Jeddah, Saudi Arabia

Saudi Journal of Health Systems Research ◽

10.1159/000517487 ◽

2021 ◽

pp. 1-6

Author(s):

Khalid Alabbasi ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Health Care ◽

Primary Health Care ◽

Public Hospital ◽

Waiting Times ◽

Care Centre ◽

Health Care Centre ◽

Transfer Policy ◽

Primary Health ◽

Before And After ◽

Ed Visits

Purpose: Excessive delays and emergency department (ED) overcrowding have become an increasingly major problem for public health worldwide. This study was to assess the key strategies adopted by an ED, at a public hospital in Jeddah, to reduce delays and streamline patient flow. Materials and Methods: This study was a service evaluation for a Saudi patient population of all age-groups who attended the ED of a public hospital for the period between June 2016 and July 2019. The Saudi initiative to reduce the ED visits at the King Abdullah Medical Complex hospital has started on August 7, 2018. The initiative was to apply an urgency transfer policy which outlines the procedures to follow when patients arrive to the ED where they are reviewed based on the Canadian Triage and Acuity Scale (CTAS). Patients with less-urgent conditions (category 4 and 5) are referred to a primary health-care practice (where a family medicine consultant is available). Patients with urgent conditions (category 1–3) are referred to a specialized health-care centre if the service is not currently provided. To test the effectiveness of ED initiative on reducing the overcrowd, data were categorized into before and after the initiative. The bivariate analysis χ2 tests and 2 sample t-tests were run to explore the relationship of gender and age with dependent variable emergency. Results: A total of 233,998 patients were included in this study, 61.8% of them were males and the average age of ED patients were 35.5 ± 18.6 years. The majority of cases were those classified as “less urgent” (CTAS 4), which accounted for 65.4%. Number of ED visits before and after the initiative was 67 and 33%, respectively. ED waiting times after the initiative have statistically significantly decreased across all acuity levels compared to ED waiting times before the initiative. Conclusion and Implication: The findings suggest that the majority of patients arrive to the ED with less-urgent conditions and arrived by walking-in. The number of cases attending the ED significantly decreased following the introduction of the urgency transfer policy. Referral for less-urgent patients to primary health-care centre may be an important front-end operational strategy to relieve congestion.

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Anticipated help-seeking for cancer symptoms before and after the coronavirus pandemic: results from the Onco-barometer population survey in Spain

British Journal of Cancer ◽

10.1038/s41416-021-01382-1 ◽

2021 ◽

Author(s):

Dafina Petrova ◽

Marina Pollán ◽

Miguel Rodriguez-Barranco ◽

Dunia Garrido ◽

Josep M. Borrás ◽

...

Keyword(s):

Poisson Regression ◽

Help Seeking ◽

Regression Models ◽

Population Survey ◽

Waiting Times ◽

Perceived Barriers ◽

Older Individuals ◽

Cancer Symptoms ◽

Before And After ◽

Diagnostic Delays

Abstract Background The patient interval—the time patients wait before consulting their physician after noticing cancer symptoms—contributes to diagnostic delays. We compared anticipated help-seeking times for cancer symptoms and perceived barriers to help-seeking before and after the coronavirus pandemic. Methods Two waves (pre-Coronavirus: February 2020, N = 3269; and post-Coronavirus: August 2020, N = 1500) of the Spanish Onco-barometer population survey were compared. The international ABC instrument was administered. Pre–post comparisons were performed using multiple logistic and Poisson regression models. Results There was a consistent and significant increase in anticipated times to help-seeking for 12 of 13 cancer symptoms, with the largest increases for breast changes (OR = 1.54, 95% CI 1.22–1–96) and unexplained bleeding (OR = 1.50, 1.26–1.79). Respondents were more likely to report barriers to help-seeking in the post wave, most notably worry about what the doctor may find (OR = 1.58, 1.35–1.84) and worry about wasting the doctor’s time (OR = 1.48, 1.25–1.74). Women and older individuals were the most affected. Conclusions Participants reported longer waiting times to help-seeking for cancer symptoms after the pandemic. There is an urgent need for public interventions encouraging people to consult their physicians with symptoms suggestive of cancer and counteracting the main barriers perceived during the pandemic situation.

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