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Joint assessment out of hours: assessing the benefits for patients and junior doctors

  • Laura Boyd (a1), Colin Crawford (a1) and Eugene Wong (a2)
Abstract
Aims and method

We examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.

Results

In the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.

Clinical implications

Joint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.

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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
Laura Boyd (lauraboyd1@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 McLernon, C, Coccia, F, Patel, AG. Adherence to the European Working Time Directive and its influence on clinical experience. Psychiatr Bull 2007; 31: 295–6.
2 Waddell, L, Crawford, C. Junior doctors are performing fewer emergency assessments – a cause for concern. Psychiatrist 2010; 34: 268–70.
3 Dunn, J, Fernando, R. Psychiatric presentations to an accident and emergency department. Psychiatr Bull 1989; 13: 672–4.
4 Royal College of Psychiatrists. Self-Harm, Suicide and Risk: A Summary (Position Statement PS3/2010). Royal College of Psychiatrists, 2010.
5 General Register Office for Scotland. National Records of Scotland: Mid-2011 Population Estimates. National Records of Scotland, 2012.
6 NHS Quality Improvement Scotland. Admissions to Adult Mental Health Inpatient Services: Best Practice Statement. NHS Quality Improvement Scotland, 2009.
7 NHS Forth Valley. Adult Mental Health Emergency Assessments. Adult Mental Health Clinical Management Team, 2011.
8 Royal College of Psychiatrists. Specialist Training in Psychiatry: A Comprehensive Guide to Training and Assessment in the UK for Trainees and Local Educational Providers (Occasional Paper OP69). Royal College of Psychiatrists, 2010.
9 Morgan, S. Positive Risk-Taking: An Idea Whose Time Has Come. Practice Based Evidence, 2004.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Joint assessment out of hours: assessing the benefits for patients and junior doctors

  • Laura Boyd (a1), Colin Crawford (a1) and Eugene Wong (a2)
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