Care of patients with mental health issues in the emergency department: a quality improvement project

We examined mental health–related visits to emergency departments (EDs) among children from 2001 to 2011. We used the National Hospital Ambulatory Medical Care Survey—Emergency Department, 2001-2011 to identify visits of children 6 to 20 years old with a reason-for-visit code or ICD-9-CM diagnosis code reflecting mental health issues. National percentages of total visits, visit counts, and population rates were calculated, overall and by race, age, and sex. Emergency department visits for mental health issues increased from 4.4% of all visits in 2001 to 7.2% in 2011. Counts increased 55 000 visits per year and rates increased from 13.6 visits/1000 population in 2001 to 25.3 visits/1000 in 2011 ( P < .01 for all trends). Black children (all ages) had higher visit rates than white children and 13- to 20-year-olds had higher visit rates than children 6 to 12 years old ( P < .01 for all comparisons). Differences between groups did not decline over time.

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Front door to post-take: an interdepartmental quality improvement project to enhance patient journeys from emergency department triage through to the medical post-take review

Future Healthcare Journal ◽

10.7861/fhj.7.1.s23 ◽

2020 ◽

Vol 7 (Suppl 1) ◽

pp. s23-s23

Author(s):

Darryl E Bernstein ◽

Dana Li ◽

Abhishek Sharma ◽

Ajitha Jayaratnam

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Front Door ◽

Emergency Department Triage

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Psychoeducation for the Frontline: Ealing Liaison Psychiatry Service (ELPS) pilot training day for London Ambulance Service (LAS)

BJPsych Open ◽

10.1192/bjo.2021.416 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S148-S148

Author(s):

Emma McLean ◽

Mariam Alexander

Keyword(s):

Mental Health ◽

Emergency Department ◽

Training Programme ◽

Training Needs ◽

Health Issues ◽

Liaison Psychiatry ◽

Mental Health Issues ◽

Legal Frameworks ◽

Almost All

AimsTo host the first ELPS training day specifically for LAS staff to improve their knowledge and understanding about mental health issues and the role of ELPS.On average 13,000 calls are received by LAS relating to mental health issues every month. Many patients seen by ELPS will have multiple interactions with LAS. ELPS has previously held training for the Emergency Department team but this innovative day was designed to extend this training commitment to pre-hospital cliniciansMethodLAS training needs were initially assessed by a bespoke questionnaire and ELPS attending another LAS training event held by the new mental health joint response car team.We then developed a training programme to match the identified training needs and which utilised the specific expertise of individual ELPS staff.14 members of the local LAS stations attended including both Paramedics and Emergency Ambulance Clinicians. The presentations covered mental state examination, suicide, risk assessment, substance misuse, legal frameworks and then a ‘challenging cases’ session to bring it all together.Pre and post course questionnaires were completed by participants, exploring attitudes and knowledge.ResultThere was a statistically significant improvement in the average self-ratings for all of the categories assessed including attitudes to mental health, confidence in assessment and knowledge relating to the process the patient will experience in the emergency department.The knowledge about the pathway and role of liaison psychiatry showed the greatest improvement with an average 4.25 increase in pre and post course rating.Almost all participants (9.2/10) would recommend this training day to a colleagueConclusionWe met our objective of improving LAS staff knowledge and understanding about mental health issues and the role of ELPS. We plan to build on this successful pilot and expand our training programme for LAS with the ultimate aim of improving patient care.

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A quality improvement project to reduce restrictive interventions in a mental health service

British Journal of Mental Health Nursing ◽

10.12968/bjmh.2020.0025 ◽

2021 ◽

pp. 1-12

Author(s):

Darren Savarimuthu ◽

Katja Jung

Keyword(s):

Mental Health ◽

Quality Improvement ◽

Positive Impact ◽

Essential Elements ◽

Quality Improvement Project ◽

Psychiatric Ward ◽

Quality Improvement Initiative ◽

Successful Implementation ◽

Evidence Based ◽

Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

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