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Crisis plans in a home treatment team before and after a quality improvement programme

  • Emily Tan (a1), Andrew Higginbotham (a1), Lorette McQueen (a1) and Kamaldeep Bhui (a1) (a2)
Abstract
Aims and method

To measure the take-up of formal crisis plans in a specialist home treatment team (HTT) serving an ethnically diverse urban population; and to implement a quality improvement programme and measure its impact on crisis plan completion. Two audits were completed of patients before and after the implementation of a quality improvement programme. Descriptive data are shown by ethnic group, by gender, and for people with multiple hospital admissions.

Results

At baseline, 16.7% of patients at high risk of admission had an HTT crisis plan, compared with 26.7% of a comparison group. Only 23.1% of the crisis plans for patients with a history of frequent admission mentioned the prevention of future admissions. Crisis plan completion improved following the quality improvement programme, when 80.0% of discharges had an HTT crisis plan; of these, 73.0% mentioned admission prevention. In the follow-up audit, 22.7% of patients in the multiple admission group had been readmitted to hospital at least once. Crisis plan completion did not appear to differ by ethnic group or gender and did not appear to be related to hospital readmission.

Clinical implications

Crisis plan completion improved with simple practical methods, but completion was unrelated to gender, ethnicity or later readmission.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Kamaldeep Bhui (k.s.bhui@qmul.ac.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Henderson, C, Flood, C, Leese, M, Thornicroft, G, Sutherby, K, Szmukler, G. Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMJ 2004; 329: 136–8.
2 Papageorgiou, A, King, M, Janmohamed, A, Davidson, O, Dawson, J. Advance directives for patients compulsorily admitted to hospital with serious mental illness. Randomised controlled trial. Br J Psychiatry 2002; 181: 513–9.
3 Department of Health. Delivering race equality in mental healthcare: an action plan for reform inside and outside services and the government's response to the independent inquiry into the death of David Bennett. Department of Health, 2005.
4 Department for Communities and Local Government. The English Indices of Deprivation 2010: Local Authority District Summaries. Department for Communities and Local Government, 2011.
5 Winners, MG, Borg, M, Kim, HS. Service user's experiences with help and support from crisis resolution teams. A literature review. J Ment Health 2010; 19: 7587.
6 Henderson, C, Lee, R, Herman, D, Dragatsi, D. From psychiatric advance directives to the joint crisis plan. Psychiatr Serv 2009; 60: 1390–1.
7 Kisely, S. A joint crisis plan negotiated with mental health staff significantly reduces compulsory admission and treatment in people with severe mental illness. Evid Based Ment Health 2005; 8: 17.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Crisis plans in a home treatment team before and after a quality improvement programme

  • Emily Tan (a1), Andrew Higginbotham (a1), Lorette McQueen (a1) and Kamaldeep Bhui (a1) (a2)
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