5 results
Long Waiting Lists and Poor Attendance - How Can Psychiatry Do Better? a Review of Services in North West Edinburgh
- Iqra Ali, Vito Balboa, Sarthak Datta, Lois Dobson, Devshi Dubey, Alexandra Eylul Oguz, Rachel Horobin, Sophie Ladha, Cassie Moore, Louise Tan, Pranav Thamarai Saravanan, Kenneth Murphy, Douglas Murdie
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S137-S138
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Aims
Increasing demand and high rates of non-attendance (DNA) lengthen waiting lists for psychiatric services, a topic of significant public and political interest. NHS Lothian data between 2009/10 and 2018/19 averaged a DNA rate of 19% for new patient appointments. Our aim was to analyse the waiting list and DNA rate for patients referred for a routine Consultant-led General Adult Psychiatry outpatient clinic appointment (OPCA) within the North-West Edinburgh Community Mental Health Team. The goal was to identify lost clinical time and areas for service development.
MethodsWe collected data of all patients on the waiting list for a routine OPCA, excluding ‘soon’ or ‘urgent’ appointments and those on the separate Neurodevelopmental Disorder waiting list.
We collected data of all OPCA attendances between 1st of January 2020 and 1st of January 2023.
In line with Royal College of Psychiatrists guidance, we allocated 30 minutes for a return patient and 60 minutes for a new patient to determine lost clinical time due to DNAs.
Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.
Results221 patients were on the waiting list for an appointment. 52% of patients were female (n = 115). The longest wait was 10 months.
Between the 1st of January 2020 and the 1st of January 2023, 1961 new patient appointments were booked. 263 were cancelled prior to the appointment. Of the appointments remaining, 30% were DNAs (n = 505), resulting in 505 lost clinical hours, an average of 168 hours/year.
9172 return patient appointments were booked. 1189 were cancelled in advance. 22% were DNAs (n = 1812), resulting in 906 hours of lost clinical hours, an average of 302 hours/year.
ConclusionDNAs have a direct impact on service provision. Were our service to reduce our DNAs to the Lothian average for General Adult Psychiatry new patient OPCA, we would save on average 61 clinical hours/year.
We will disseminate this information to the NHS Lothian Digital Experience Mental Health Team to support the introduction of a text reminder service, before involving the NHS Lothian Quality Improvement team to explore the impact of this intervention on DNAs.
Furthermore, being placed on a waiting list can be an uncertain time for patients. We will create a waiting list pack for patients, including information of local supports and emergency contacts. We will pilot this in our sector before disseminating to other teams in Lothian.
Physical Health Monitoring of Patients Prescribed Depot Antipsychotic Medication in North West Edinburgh Community Mental Health Team (CMHT)
- Adrianna Klejnotowska, Robyn Bailey, Alexandra Thompson, Jakub Wojtowicz, Josh Haggart, Hamsi Evans, Hae-young Choi, Adam Mallis, Anna MacLeod, Douglas Murdie, Vikki Argent
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S149-S150
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Aims
To assess the effect of interventions in the physical health monitoring of patients prescribed depot antipsychotic medications. We hypothesised that compliance with monitoring would improve post-intervention. It is well recognised that patients with severe mental illness have a significantly reduced life expectancy. Depot antipsychotic medication increases the risk of cardiovascular disease, metabolic syndrome, stroke and type 2 diabetes. The SIGN guidelines recommend that all patients on antipsychotic medications should have annual physical health monitoring. Baseline data of patients on depot antipsychotic medication in North West (NW) Edinburgh CMHT in 2019 demonstrated that this was not being achieved. We sought to create interventions to improve compliance with physical health monitoring for patients on depot antipsychotic medication.
MethodsBaseline data were collected in 2019 for all patients under NW Edinburgh CMHT receiving depot antipsychotic medication (60 patients). The data addressed 9 domains including smoking status, blood monitoring, BMI and physical monitoring.
Following the baseline data collection interventions were put in place to increase compliance with monitoring. These interventions included a physical health questionnaire and training of staff in the CMHT to perform phlebotomy and ECGs.
Following these interventions the data (74 patients) were re-audited in 2020 following the same domains.
After this initial re-audit a physical health monitoring clinic was implemented in order to specifically target this patient population. The data (66 patients) were then re-audited in 2021.
ResultsBaseline data identified that domains were reached between 8% (Lipid monitoring) and 51% (glucose monitoring). Following the initial interventions 77% of domains improved in compliance. Between the two periods, notable improvements were observed in the monitoring of Blood Pressure (9% to 37%), ECG (20% to 43%) and lipids (29% to 46%). There was however a decline in all domains between the 2020 and 2021 data, with 66% of domains still having improved compared to 2019 data.
ConclusionOverall, interventions have improved compliance with monitoring of physical health for patients on depot antipsychotic medications. It is likely that continuing effects of the COVID-19 pandemic contributed to the decline between the 2020 and 2021 data. As a result of this audit a weekly physical health monitoring clinic has been set up and once formally established it is hoped that compliance with physical health monitoring will continue to improve. Limitations include effects of COVID-19 pandemic, inconsistency in documentation and patient non-attendance to the monitoring clinic. We recommend further audit cycles, with additional interventions being implemented as identified.
7 Day Follow-Up Arrangements Following Discharge From Psychiatric Hospital; How Do We Perform?
- Jemima Alston, Rozet Balliou, Naomi Erlebach, Zach Evans, Anna Grieve, Silas Hand, Shreya Jindal, Phei Yi Lim, Matt Shaw, Chukyi Wama, Ben Meadowcroft, Douglas Murdie
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S141
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Aims
The first 7 days following discharge from inpatient to community psychiatric services is a period that is associated with an increased risk of suicide. NICE Guideline 53 recommends that patients discharged from inpatient psychiatric services should be reviewed by relevant community services within 7 days. We aim to determine how different teams in NHS Lothian performed in meeting this recommendation, and to ascertain the outcome of a specific intervention in North-West Edinburgh (NW).
MethodsWe collected data of NW, North-East (NE), South-West (SW), South-East (SE) Edinburgh, East Lothian and Midlothian patients discharged from General Adult Psychiatry wards in the Royal Edinburgh Hospital for the calendar year of 2021. East and Midlothian were used as a comparison to Edinburgh services as the former have an integrated inpatient and community team.
The data focused on the percentage of patients followed-up within 7 days of discharge. We also collected data for all NW CMHT patients discharged between January 2018 and November 2021 to analyse the intervention of using ‘Estimated Discharge Dates’ in ward rounds implemented in June 2020. Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.
Furthermore, qualitative data were collected anonymously from staff within NHS Lothian in the form of an online questionnaire to ascertain strengths and weaknesses of the current systems.
ResultsOver the calendar year of 2021, 1,398 patients were discharged. The average age was 41 years old.
Regarding percentage of patients receiving 7 day follow-up, East Lothian (n = 191/249; 76.7%) and Midlothian (n = 95/122; 77.9%) performed better than Edinburgh services; NW (n = 173/268; 64.6%), NE (n = 172/301, 57.1%), SW (n = 155/247, 62.8%), SE (n = 123/211; 58.3%).
The intervention in NW in June 2020 did not have a significant impact on 7 day follow-up.
The questionnaire identified difficulties in transitions from inpatient to community care, particularly communication between teams.
ConclusionThe performance of East and Midlothian versus Edinburgh services is interesting given their integrated model. This appears to support the findings of the questionnaire.
The lack of impact of the intervention in NW will need explored further with the team to identify difficulties.
Rather than complete service remodelling, perhaps moving towards a more integrated approach such as allocated discharge-coordinating community and inpatient nurses would be worthwhile. We will involve the NHS Lothian Quality Improvement team in exploring this to improve patient outcomes.
Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh
- Ritika Devadas, Douglas Murdie, Idris Thomas, Rhona Hannah, Wiktoria Karbowniczek, Tara Kinney, Oscar Lacey-Solymar, Adam Łukaszuk, Seona MacDonald, Sarah McIntosh, Danya Taha, Charles Taylor
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S74-S75
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Aims
COVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).
MethodMeasures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.
Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.
In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.
ResultReferrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).
Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.
Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.
ConclusionThe COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.
The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.
Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.
Physical health monitoring of patients prescribed depot antipsychotic medication in north west Edinburgh community mental health team
- Douglas Murdie, Jakub Wojtowicz, Alexandra Thompson, Anne MacLeod, Adam Mallis, Hamsi Evans, Joshua Haggart, Hae Choi, Vikki Argent
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S336-S337
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Aims
To monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.
BackgroundAntipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.
MethodThe records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.
ResultWe identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.
ConclusionThere is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.