2 results
Improving COVID-19 Vaccination Uptake in Service Users Admitted to an Acute Inpatient Psychiatric Ward
- Miranda Holliday, Lisanne Stock, Bhina Patel, Fidaa Natour, Victor Cohn, Mercedes Chavarri
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S157
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Aims
It is well known that individuals suffering from mental illness have more comorbidities and lower life expectancies compared to the general population. It is unsurprising therefore, that these individuals are more vulnerable to both contracting COVID-19, and developing severe illness if infected. When patients are admitted to a psychiatric inpatient unit this offers an invaluable opportunity to ensure that unvaccinated patients are identified, and if consenting, are supported to receive whichever dose of the vaccine they require. We undertook an audit to examine the proportion of patients admitted who had not received their first, second or third dose of the COVID-19 vaccination. Reviewed in the context of gender, age, ethnicity, legal status, mental health diagnoses and additional comorbidities, in order to determine any trends that might assist in improving uptake. We then repeated the audit aiming to offer the appropriate COVID-19 vaccination to every newly admitted unvaccinated patient. If refused, to then council reluctant patients, providing simple, understandable vaccine information, and to re-offer vaccination.
MethodsThe audit took place on a mixed adult psychiatric inpatient ward in London.
The first cycle of the audit was completed retrospectively. Data were collected from the electronic notes of new admissions from November and December 2021 (total 41). This included information on COVID-19 vaccination status, and documentation of vaccines offered and administered during admission. Additional information was also compiled to calculate risk stratification scores.
Subsequently, we repeated the audit cycle for admissions in January and February 2022 (on-going). However, this time with the aim that all patients have their COVID-19 vaccination status documented promptly, and that their next vaccination is offered/administered during admission if required.
ResultsResults from the initial audit cycle showed 33/41 patients had not received a full set of COVID-19 vaccinations (or no vaccination record found). Only 6/33 unvaccinated patients were offered the next vaccination during admission, and 3/33 actually received one. 21/33 patients without a full set of vaccinations were BAME (Black, Asian and minority ethnic).
Initial results from the second cycle showed an improvement in the number of patients offered the vaccine. 5/10 unvaccinated patients were offered vaccines in January, however data collection is ongoing.
ConclusionAlthough our data set is not yet complete, initial results show that a simple intervention such as early identification of unvaccinated patients on admission, can act as a prompt to clinicians to ensure vaccines are offered. Thereby, increasing vaccine compliance in this vulnerable patient group.
Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)
- Margarita Kousteni, John Cousins, Ajay Mansingh, Maja Elia, Yumnah Ras, Mercedes Chavarri, Marilia Gougoulaki, Imo Akande
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S202
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Aims
Triaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.
The aims of this quality improvement project (QIP) were:
a) to reduce the number of inappropriate referrals received by the team
b) to reduce the number of inappropriate referrals accepted by the team
MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).
Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).
Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).
Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).
71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.
ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.