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Dr Vishelle Kamath Consultant Psychiatrist SEPT

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Presentation on theme: "Dr Vishelle Kamath Consultant Psychiatrist SEPT"— Presentation transcript:

1 Dr Vishelle Kamath Consultant Psychiatrist SEPT
Providing an Accessible Mental Health Liaison Service to a General Hospital: Challenges and Solutions   Dr Vishelle Kamath Consultant Psychiatrist SEPT

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 Problem The 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 patients Will measurably improve outcomes with regards to health, finances, patient and carer experience Be implemented by December 2013

6 Root cause Analysis National Drivers Media/ Expectation L&D

7 Root cause Analysis The 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 allocation The 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 service Commissioned Psychiatric Liaison Service

9 Comparison of Strategies
Strategy Cost Effectiveness Quality Accessibility Risks Stakeholder Support Time to effect Potential saving Continue with existing service Augmented Service Commissioned Psychiatric Liaison Service

10 Key Milestones Implementation Modelling of Options
Trial of Augmented Service Re-evaluation Position statement Idea generation Consultation with Stakeholders Business planning &Service Specification The beginning

11 Implementation Steps Pathways & Operational Policies
Risks and risk management strategies Outcome Measures and KPI’s Financial management & Reporting arrangements IT systems Workforce recruitment Governance Structures Service Review

12 Evaluation Plan Strategic Aim Equitably accessible, high quality service that improves patient outcomes To facilitate efficiency in the service with a resulting financial saving Short Term Improved patient experience Improved quality of care Long Term Better patient satisfaction Financial savings

13 Measurable Outcomes Improved patient and carer satisfaction
Reduced length of inpatient stay in the general hospital Avoidance of admission to the general wards Reduced frequency of readmission after discharge The proposal costs approximately £300,000 per year The 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 million Improved patient and carer satisfaction Improved patient choice Reduced 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&D This 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 hospital 5. Monitoring of discharge destinations e.g. more people discharged home Secondary 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 wards CRHT 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 implemented To 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 by The right provider The right time Transformational Leadership Influence and relationships Achieving consensus – unfiying objectives

17 Lessons Learnt ..... The spending paradox Stakeholder management SEPT
Stellar reputation as a provider of excellent services Track record of successful service transformation The spending paradox Spend Averse Climate Investing to save

18 Lessons for me Maintaining momentum...

19 Lessons for me Time distortion!

20 Lessons for me Sequential problem solving

21 Lessons for me More than just numbers....


23 Thank you!

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