Joan Blackwood

Clinical Lead MH Service Re-design

Frances Paton

Business Intelligence Manager (Partnerships)

Fiona McMahon Senior Practitioner,

Re-admissions/Service Improvement

The A&E and Mental Health Pathway

“Improving Care Delivery

and the Patient Experience”

Background

• 2010/2011 GG&C Performance and Development Plan – Contribution to Acute Services Framework (HEAT 10)

• GG&C A&E Attendances Steering Group• GG&C MH and A&E Acute Interface Working Group

(Lead - Calum MacLeod Head of Mental Health South Glasgow)

MH and A&E Acute Interface Working Group

• Multi disciplinary and management representation from A&E, Mental Health, Addictions, A&E Attendances Group, Homelessness, Liaison, Information Services etc.4 hour breaches + reasonsRepeat attendancesClinical PathwaysClinical Sub Group

• Wait for 1st Assessment

• Wait for Specialist Assessment

• Wait for Psychiatric Bed

• Wait for Transport

Areas that need to be explored - those with common causes for delay

Information

Greater Glasgow & Clyde – Phase 1

• Identify patients who are A&E Breachers

• Identify all A&E attendances who have a MH diagnosis and are known to our services.

• Extracted all Mental Health A&E presentations. (North & South A&E – not Clyde)

• Extracted all MH data recorded on PIMS (Inpatient, CMHT, Crisis etc).

• Resulted in ‘draft’ suite of information reports linking in with Service use .

To do this we -

• Merged into one database to identify patients. (Patient Linkage)

Snapshot of Information Reports (Period: 01/10/2009 – 31/03/2010)

• Better use of information to help inform decision making.

Last known MH Service prior to A&E presentation

Diagnosis category Count %

Alcohol 1,880 42%

Drug 1,240 27%

Psychiatric / Other 1,086 24%

Self harm (no drug / alcohol) 313 7%

Total: 4,519  

Presentations where A&E Diagnosis is Categorised

Known to Mental Health Services Known to Adult CMHT

Presentations % Patients % Presentations % Patients %

3,880 61.6 2610 53.7 1,644 42% 1071 41%

7,057 MH presentations, CHI present in 6,296 (4,864 patients) so Reports are based on these 6,296 records

Last Known Service Prior to A&E Presentation Presentations

% of Total Known Prior to A&E Presentation

Inpatient 575 36%

CAT Team 402 25%

Adult CMHT 333 21%

Addictions Team 122 8%

Crisis Team 64 4%

Liaison Team 49 3%

Esteem 23 1%

PCMHT 20 1%

Homeless 11 1%

Other 7 0%

Elderly CMHT 4 0%

Total Known to Service Prior to A&E Presentation 1610 100%

Snapshot of Information Reports

• Better use of information to help inform decision making.

Associated CMHT’s for Patient

  Unique % of Total   % of Total Number of Patients with this amount of Presentations

Linked CMHT Patients Patients Presentations Presentations 1 2 3 4 5 6 7 8 9 10 12 14 16 22

Arran - Known 131 5% 196 5% 100 18 4 3 2 2 2              

Arran – Not Known 278 11% 450 12% 194 45 19 4 10 4     1 1        

Arran Total 409 16% 646 17% 294 63 23 7 12 6 2   1 1        

Riverside - Known 160 6% 231 6% 119 23 9 6 3                  

Riverside - Not Known 147 6% 212 5% 125 11 4 2 2       1 1     1  

Riverside Total 307 12% 443 11% 244 34 13 8 5       1 1     1  

Springpark - Known 98 4% 178 5% 70 16 3 4 1 1   1   1       1

Springpark - Not Known 177 7% 252 6% 139 20 10 3 2 1 1 1            

Springpark Total 275 11% 430 11% 209 36 13 7 3 2 1 2   1       1

Anvil - Known 93 4% 145 4% 68 11 8 4   1     1          

Anvil - Not Known 145 6% 185 5% 115 25 2 2   1                

Anvil Total 238 9% 330 9% 183 36 10 6   2     1          

Shawpark - Known 93 4% 157 4% 68 14 3 3 2 1       1   1    

Shawpark - Not Known 138 5% 229 6% 99 22 8 3 1 1     3   1      

Shawpark Total 231 9% 386 10% 167 36 11 6 3 2     3 1 1 1    

CLINICAL PORTAL

• What is Clinical Portal?

• Mental Health data on Clinical Portal

• Mental Health Sparra on Clinical Portal

A web-based system that presents all electronic information for a patient in a single location

The Portal uses technology to provide a clinician-friendly view of information from multiple information sources.

Data items to be published in the Mental Health clinical Portal are:o Alertso Open Referralso Diagnoseso Last Contacto Last Clinic Attendance

Predictive algorithm, developed by ISD. It identifies patients aged 15 years and over at risk of re-admission to a psychiatric hospital or unit.

CLINICAL PORTAL – Mental Health PIMS

CLINICAL PORTAL – Mental Health PIMS

CLINICAL PORTAL – Mental Health SPARRA

CLINICAL PORTAL – Mental Health SPARRA

Next Steps

• ‘Work in Progress’

• Consolidate and agree information requirements between services

• The initial information analysis has prompted questions about Clinical Pathways between A&E and Mental Health including Addictions

Mental Health, A&E & Addictions Patient Pathway

As a result of the data collection exercise reports can now bemade available to highlight :

• Patients who are known to both A&E and Mental Health Services

• Are regular attendees at A&E• Regularly breach the 4 hour target

But

• We needed to gain a better understanding of the patient journey.

• To identify gaps, blocks, delays, demand and capacity issues across services.

• Most importantly we wanted to know what was happening to patients.

• Sub-Group established included clinical staff from : A&E, Adult Community Mental Health, Crisis (day & night OOH) Liaison Psychiatry, Inpatients and Addictions

• Remit of Group: To carry out a process mapping exercise to accurately inform

routes into and out of A&E To test clinical scenarios across the process map and identify

current systems To support effective interface across all services

Mental Health, A&E & Addictions Patient Pathway

Process

• Three meetings – task and finish approach

• Plan – scope and range of the work

• Process map – involving all stake holders

• Follow up issues identified and action plan developed

Next Steps

• Feedback Progress – MH and A&E Acute Interface Working Group, GG&C Attendances Group

• Four dimensions to the action plan –– Clinical Practice– Information– Service Response– Patient Experience

• Extend membership of Clinical Group to reflect the further work required on pathways

• Information – Using information to help inform and improve clinical practice.

• Clinical Portal – A&E Staff will have access to Mental Health Service Data.

• Clinical Response – What is the expected response by A&E and Mental Health Staff.

• Develop Clinical Practice Guidelines – to access management/crisis plans, develop case review mechanisms.

• Service response – further work to be done with other parts of the Mental Health Service i.e. Addictions

Action Plan – “A Taster”