G74 From doorway to discharge: a multi-disciplinary quality improvement innovation to improve the camhs patient journey
Year: 2018
Type: conference-paper
Abstract: Background Mental health problems are increasingly common among children and young people (CYP) with 1 in 8 reporting symptoms.1 Our service experienced 3 presentations per week within 2016 which further increased by 60% this year. From doorway to discharge each patient will see 7 different healthcare professionals. This may result in frustration at perceived lack of communication between staff, lack of knowledge2 and need to repeat their story. Aims Create a multi-disciplinary mental health pro-forma for CYP presenting to hospital with mental health difficulties. Assist staff to complete appropriate, informed assessments. Improve patient experience by reducing need for story repetition. Methods Plan: 2 independent retrospective case-note analyses of 27 presentations to the Emergency Department (ED) over a 4 month period of patients aged between 14 and 15, and 24 admissions to the ward over a 3 month period of patients aged under 16. Do: Implemented a pro-forma encompassing the patient journey including key aspects identified for improvement from data analysis; risk assessment, safeguarding, physical and mental state examination (MSE). Study: Second data-analysis followed a 6 week pilot period. A further retrospective case-note analysis of 19 admissions to the ward via the ED. Results Within ED there was improvement regarding risk assessment (92.9% vs 10%), safeguarding (100% vs 52.9%) and MSE (92.9% vs 51.9%). Ward data demonstrated a lack of engagement with the pro-forma, no change to those fully completing risk assessment (0%) and deterioration in MSE (57% vs 35.7%) and physical examination (70% vs 57.1%). Discussion and future direction The mental health pro-forma resulted in clear improvement in outcomes within ED assessments across many aspects. These improvements may be replicated on the wards by increasing staff engagement with the pro-forma. Suggestions to achieve this aim, as well as other improvements, make up the ‘act’ aspect of our PDSA cycle: Abstract G74 Figure 1 Page 1 and 2 of the paediatric mental health admission document Multi-disciplinary education on mental health presentations and use of pro-forma. Pro-forma colour coding according to discipline for clearer access. Patient experience analysis. Further data analysis is planned for early 2018.
Authors: F Teasdale, A Shetty, S Mullen, A Watkins, J Davies, A Gowman, M Glover
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
OpenAlex ID: W2790747005