1 Dr Vishelle Kamath Consultant Psychiatrist SEPT Providing an Accessible Mental Health Liaison Service to a General Hospital: Challenges and Solutions Dr Vishelle KamathConsultant PsychiatristSEPT
2 Background The L & D – a large district general hospital A wide and diverse population from 3 different counties£3.6 million - The total cost to the commissioning body, NHS Luton, for admissions to the L&D for psychiatric presentations including dementia, self-harm and substance misuse was approximately ( )
3 Background continued...A high proportion of patients in general hospitals have co–morbid mental health problems, leading to poorer health outcomes and increased healthcare costs.[Joint Commissioning panel for mental health]Mental health service users2 have double the rate of hospital attendances compared to the general population3 – across A&E, inpatients and outpatient services[ The Health and Social Care Information Centre (HSCIC)]
4 The ProblemThe current level of psychiatric input into the L&D cannot meet demand.
5 Objective To develop a psychiatry service that : Will meet the demand Is accessible to all patientsWill measurably improve outcomes with regards to health, finances, patient and carer experienceBe implemented by December 2013
6 Root cause AnalysisNational DriversMedia/ExpectationL&D
7 Root cause AnalysisThe current model of mental health service provision to the L &D is one of ad hoc psychiatric consultations with separate services for adults and older adults (those aged 65 and over).The growing demand for psychiatric assessments and input cannot be met at the current levels of resource allocationThe result of this inequality between supply and demand is placing immense pressure on the hospital- increased lengths of stay- hospital acquired infections, poorer patient experience and poorer health outcomes.
8 Strategic Options Continue with the Existing Service Augment the existing serviceCommissioned Psychiatric Liaison Service
9 Comparison of Strategies StrategyCostEffectivenessQualityAccessibilityRisksStakeholder SupportTime to effectPotential savingContinue with existing service↑Augmented ServiceCommissioned Psychiatric Liaison Service↓
10 Key Milestones Implementation Modelling of Options Trial of Augmented ServiceRe-evaluationPosition statementIdea generationConsultation with StakeholdersBusiness planning &Service SpecificationThe beginning
12 Evaluation PlanStrategic AimEquitably accessible, high quality service that improves patient outcomesTo facilitate efficiency in the service with a resulting financial savingShort TermImproved patient experienceImproved quality of careLong TermBetter patient satisfactionFinancial savings
13 Measurable Outcomes Improved patient and carer satisfaction Reduced length of inpatient stay in the general hospitalAvoidance of admission to the general wardsReduced frequency of readmission after dischargeThe proposal costs approximately £300,000 per yearThe cost savings are based on the analysis of data at Birmingham City Hospital RAID service between 1st December st July 2010*Savings from reduced Length of Stay = £1.75 millionImproved patient and carer satisfactionImproved patient choiceReduced delays in accessing mental health input*Economic Evaluation of Liaison Psychiatric Service Centre for Mental 2011
14 Agreed KPI’s KPI Comment/Query Notes 1.To reduce the number of emergency admissions.This refers to emergency admissions via A/E to the L&D.If L&D admissions, SEPT will be dependent on L&D to report.2. To reduce the number of readmissions.This refers to emergency readmissions via A/E to the L&D.If L&D readmissions, SEPT will be dependent on L&D to report.3. To reduce the number of delayed discharges from the L&D due to mental health causes.Will need to define which delayed discharge codes will need to be monitored.SEPT will be dependent on L&D to report.4. EAU admission avoidance in L&DThis is to monitor those patients that are admitted to the Emergency Admissions Unit in the L&D from A&E.Measure used in the economic evaluation of RAID by the LSE. The rationale is that the RAID model demonstrated a reduction in admissions to the equivalent unit within the general hospital5. Monitoring of discharge destinations e.g. more people discharged homeSecondary measure suggested in the economic evaluation of RAID by the LSE.6. Length of time from referral by L&D to;Could compare to pre service implementation if baseline information gathered.1 working day for assessment on base wardsCRHT response times to A&E to be reduced from 4 hours to 1 hour
15 Agreed KPI’s cont….7. To reduce L&D delayed transfers of care due to MH causes.Will need to define which codes will need to be monitored.8. Increase in referrals to Psychiatry Liaison Team (PLT).Would need a baseline, not available as a new service, could suggest a trajectory.9. Total number of referrals.10. Proportion of referrals assessed as appropriate.11. Patient/carer satisfaction before and after implementation.To be measured by Patient experience team, to work with L&D patient experience team.12. L&D hospital clinical teams satisfaction before and after service implementedTo be measured by patient satisfaction team.13. L&D Hospital staff awareness of liaison service..
16 Lessons Learnt So a new service..... Why all the fuss? The right proposal byThe right providerThe right timeTransformational LeadershipInfluence and relationshipsAchieving consensus – unfiying objectives
17 Lessons Learnt ..... The spending paradox Stakeholder management SEPT Stellar reputation as a provider of excellent servicesTrack record of successful service transformationThe spending paradoxSpend Averse ClimateInvesting to save