Milestone 8 Update HEAT T10 Business Meeting 30 th March 2010 Yvonne McCallion Integrated Admission and Discharge Manager NHS Fife
Patients Referred To And / Or Seen By Mental Health Team In A&E By Month 01/01/2009 – 31/12/2009 70 300 60 250 Number of Patients Seen by Psychiatry Average Length of Stay in A&E 50 200 40 150 30 100 20 50 10 0 0 t l y y r y y h e s r i r r e r a l e e r r c n u e u p b a a M b b r u b J g A o u u a m J m u m n t r M b A c e e a e O v c e t J F p o e e N D S Month of Attendance VHK QMH VHK QMH 4 Hours
Patients Referred To And / Or Seen By Mental Health Teams In A&E By Hour 01/01/2009 - 31/12/2009 40 35 30 Number of Patients Seen by Psychiatry 25 20 15 10 5 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Hour of Arrival VHK QMH
Patients Referred To And / Or Seen By Mental Health Teams In A&E By Day 01/01/2009 - 31/12/2009 90 80 70 Num ber of Patients Seen by Psychiatry 60 50 40 30 20 10 0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Day of Arrival VHK QMH
Referral Source Of Patients Referred To And / Or Seen By Mental Health Team 01/01/2009 – 31/12/2009 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Emergency Self Referral Nhs 24 Other Hospital General Gp Out Of Other Ward Or Victoria Other Ward Or Services Practitioner Hours Service - Dept, Vhk Hospital, Kdy - Dept, Qmh Pces A&E Dept VHK QMH
Outcome Of Patients Referred To / Seen By Mental Health Team 01/01/2009 - 31/12/2009 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Discharged - Admitted Discharged - Discharged - Transferred Incomplete - Incomplete - Incomplete - Incomplete - Other Incomplete - With Referral With Follow No Follow Up Patient Left Patient Left Patient Left Patient Patient Up by Before After Before Being Refused Removed by Primary Assessment Treatment Treated Treatment Police Team Completed Started VHK QMH
Number of Patients in A&E Seen by or Referred to Psychiatry by Age Group 01/01/2009 - 31/12/2009 160 140 120 100 80 60 40 20 0 4 & Under 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 & over VHK QMH
Improve Mental Health Liaison And Addiction Services From May 2010: • Involve mental health clinicians and managers in A&E breach analysis for core sites, concentrating initially on sites with difficulty sustaining 98% compliance Current Arrangements • Mental health breaches sent weekly to local mental health teams • Within mental health – named lead for 4 hour emergency access standard • Mental health lead participates in 4 hour emergency access pathway groups • A&E Consultant meets with mental health and A&E staff to look at process Challenges / Future Actions • Breach analysis undertaken by A&E staff – some disagreement from mental health / inaccuracy around breach causes • No lead identified as yet for T10 • Mental Health Doctor engagement
Mental Health Patients – Performance Against 4 Hour Emergency Access Standard QMH VHK Number of % Number of % Number of Number of Patients compliance Patients compliance Psychiatry Psychiatry Referred to with 4 hour Referred to with 4 hour Breaches Breaches Psychiatry target Psychiatry target November 38 1 97.4% November 54 1 98.1% December 42 3 92.9% December 27 4 85.2% 40 1 97.5% 39 3 92.3% January January February 35 0 100.0% February 41 5 87.8%
Improve Mental Health Liaison And Addiction Services From May 2010 • Agree and work towards implementation of mental health quality standards for the time taken to assess A&E attendees Current Arrangements • As part of Emergency Access pathway group work, A&E are seeking to develop service level agreements with specialties and services to support achievement of the 4 hour emergency access standard – mental health included • Introduction of mental health Unscheduled Care Team in July 2009 – time standards considered at that time but abandoned • Improvements in mental health response times to A&E since introduction of Unscheduled Care Team • Now - early discussions between A&E and mental health around development of mental health standards for A&E Challenges / Future Actions • Reluctance from mental health teams to agree mental heath quality standards ‘until issues around consistent breach analysis are resolved’ • Availability of national mental health quality standards – current guidance refers to England and Wales only ‘Managing Urgent Mental Health Needs in the Acute Trust – Academy of Medical Royal Colleges (2008)’ • No local mental health team awareness / acknowledgement of drive by SG and Scottish division of Royal College of Emergency medicine to introduce such standards – although resistance by Royal College of Psychiatry
Improve Mental Health Liaison And Addiction Services From May 2010 • Review local arrangements for alcohol services including alcohol liaison service to core sites, and speed of access to community alcohol services after A&E attendance Current Arrangements • 2 year fixed term programme of alcohol brief interventions in A&E • Completion of screening tool for all patients over 16 years • Alcohol liaison nurse presence in both A&E sites (Monday to Friday 0900-1700hrs) • Referral to addiction services by alcohol liaison nurse if required • Out of hours - appointments made for patients by A&E staff • A&E staff training around screening • Addiction services teams working towards HEAT target A11 – ‘local’ target by December 2010 that everyone accessing drug and alcohol service will have a comprehensive assessment undertaken within 4 weeks of referral Challenges / Future Actions • Risk of increase in non – emergency alcohol related attendances to A&E • What happens at end of 2 year period? NHS 24?
Improve Mental Health Liaison And Addiction Services From May 2010 • Review mental health service provision for core sites by age bands • Review alternative (i.e. out of hospital) urgent mental health service provision with a specific focus on Monday-Sunday 0900 – 2100 Current Arrangements • Since July 2009 Unscheduled Care Team - single point of access for all mental health services 24 hours a day on core sites • Initial assessment by nurse with exception of paediatric referrals • Improved accuracy of signposting to appropriate mental health ‘subspecialties’ and external agencies by Unscheduled Care Teams Challenges / Suggested Future Actions • Requirement to scope mental health services, e.g. in hours / out of hours, age band of patients treated, mental health ‘sub specialities’, source of referrals for each service, referral route to each service • Requirement to further analyse mental health attendances to identify existing links with mental health services, availability of these services and the rationale for attending A&E
Additional Actions • Analysis of NHS 24, PCES and GP ‘mental health referrals’ to A&E – why not direct emergency referrals to mental health? • Highest number of patient outcomes for patients seen by / referred to mental health is discharge with referral – requirement to analyse where the referrals are to and whether there could not be direct access to them by particular referrers avoiding A&E • Understanding why peak numbers of patients present between 1800-1900hrs • Understanding why the peak days are Sunday and Monday • Are presentations different at weekends and weekdays? – link to availability of mental health services
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