Raid trials tribulations and evaluations
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RAID trials, tribulations and evaluations. Dr George Georgiou RAID Clinical Director. The Overview. Project initiated in 2008 in Birmingham Commenced December 2008 Internal evaluation programme Independent economic evaluation – Mike Parsonage and Matt Fossey , Centre for Mental Health

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Raid trials tribulations and evaluations

RAID trials, tribulations and evaluations

Dr George Georgiou

RAID Clinical Director


The overview

The Overview

Project initiated in 2008 in Birmingham

Commenced December 2008

Internal evaluation programme

Independent economic evaluation – Mike Parsonage and Matt Fossey, Centre for Mental Health

Prof Martin Knapp – LSE

Rolled-out across 5 acute hospital sites, Dec 2011 – Apr 2012


Older adult mental health

Older adult mental health

Up to 70% of hospital beds are occupied by older people

Audit commission, 2006, Living Well in Later Life

2000-2010, hospital stay for 60-74 increased by 50%, over 75 by 66%

Hospital Episode Statistics, 09-10

Dementia, Depression and Delirium

Case for change- Mental Health liaison Service for Dementia Care in Hospitals:

Strategic Commissioning Development Unit (SCDU), 21st July 2011.


Older adult mental health1

Older adult mental health

Concerns from Nursing staff :

managing challenging or difficult behaviour

communication difficulties

not having enough patient time

Concerns from Families:

nurses not recognising or understanding dementia

lack of opportunity for social interaction

lack of personal care

patients not being helped to eat and drink

the person with dementia not being treated with due dignity and respect

Alzheimer’s society report: Counting the cost (2009)


Alcohol use disorders

Alcohol use disorders

88% of adults in the UK drink alcohol

38% of men: alcohol use disorder

16% of women: alcohol use disorder

(Alcohol Needs Assessment Research Project, 2005)

Annual healthcare cost of £1.7 billion

(National Indicators for Local Authorities and Local Authority Partnerships, 2009)

Alcohol related admissions and presentations

Alcohol specific admissions and presentations

Tri-morbidity


Adults of working age

Adults of working age

Deliberate self-harm:

In the top five reasons for admission in the UK

170,000 admissions per annum

Inadequate training leads to negative attitudes and poor care

Patient non-engagement and repeated self-harm behaviour

Suicide completion

Resource intense with little positive outcome.

Kripalani et al, (2010) Integrated care pathway for self-harm: our way forward. British Medical journal, 27:544-546

Kapur, N (2006) Self Harm in the general hospital. Psychiatry, 5 (3) 76-80

National Institute for Clinical Excellence (2010) Guidelines for Self harm.


Physical and mental health

Physical and mental health

25%: Patients with a physical illness also have a mental health condition

60%: Rate in the over 60s

Depression and anxiety: 2-3 times more common in those with physical long-term illness

Neuropsychiatry; postnatal psychiatry; eating disorders

MUPS:

long term disability and dissatisfaction

most hospital specialities

care costs estimated at £3.1 billion per annum


Key principles

Key principles

  • Single point of contact

  • 24/7

  • Rapid response

  • Acute hospital based- Integrated

  • Broad spectrum of mental health disorders

  • Integrated

    • all age groups

    • physical and mental health staff working together

    • case load and staff training

    • part of the hospital system and machinery

    • Part of the community pathway and service delivery

  • Flexible to local need.


  • Expected outcome with raid

    Expected outcome with RAID

    • EARLY DETECTION: a proactive mental health RAID team are aware of the case at an early stage

    • COMPREHENSIVE ASSESSMENT AND REVIEWS: complex multi disciplinary assessment with regular reviews as appropriate

    • EFFECTIVE CARE PLANNING: confidence that a patient can be managed away from the hospital, e.g. at home with appropriate package of support

    • REDUCED LOS AND IMPROVED OUTCOME: facilitates earlier discharge and better outcome for patient.


    Raid an established speciality

    RAID: An established speciality

    RAID


    Raid trials tribulations and evaluations

    Mental Health Network: NHS Confederation

    Briefing: November 2011 (228)Liaison services can:- Save money- Improve health and well-beingLiaison services are:- An essential component of effective acute hospital care.


    Evaluation in a nutshell

    Evaluation: In a nutshell

    Total savings:

    £3.55 million to NHS

    At least 44 beds/day

    £60,000/week to social care cost

    Invest £1 in a RAID model and save £4


    Wider potential benefits

    Potential Benefits of RAID

    Wider Potential Benefits

    Complaints

    Social care £

    Staff satisfaction

    Patient satisfaction

    Outcomes

    Considered in this Study

    Acute staff confidence in

    dealing with MH conditions

    Staff sickness

    Readmission

    rates

    Inpatient LoS

    Demand for community MH services

    Time in A&E

    Discharge destination

    A&E re-attendance rates

    Admission rates

    fro A&E

    MH outcomes

    SUIs

    Quality

    Time to readmission

    Acute staff training

    Acute £

    Prov / Comm

    Referring / Signposting to

    community MH services

    Security


    Outcome of csu evaluation

    Outcome of CSU evaluation

    • Some savings made at front door:

      -5.9% City Hospital:

      -14.4% Heartlands Hospital: -9.8% Good Hope Hospital

      -8.2% QEH

    • £485,000 saving on saved admissions for commissioners

    • £557,000 on avoided admissions for providers

    • Most savings made on the wards:

    • £1,635,863 saving on reduced length of stay for commissioners

    • £5.3M on reduced length of stay savings for provider

    • Overall finding of for every pound spent, £4 saved


    Quality

    Quality

    • Discharge Outcome Form:(DOF)

    • Patient satisfaction:semi-structured telephone interviews

    • Staff satisfaction:semi-structured face to face or telephone interviews

    • Teaching and training:feedback questionnaires

    initial accreditation:September 2010

    innovation in mental health: November 2010


    Results from 184 completed patient satisfaction questionnaires

    Results from 184 completed Patient satisfaction questionnaires

    • 93% of patients agreed that they were seen in good time

    • 99% of patients agreed that they were treated with dignity and respect

    • 98% said that the team listened carefully

    • 98% said that the RAID staff gave them time to talk

    • 92% said that seeing someone from the Mental Health Trust was helpful to them

    • 91% said that they felt involved in deciding what help they needed

    • 96% said that they were satisfied with the support that was offered to them


    Raid trials tribulations and evaluations

    Service user comment of service prior to RAID

    “Basically I didn’t feel very good at all and I was being pushed out of the hospital that’s the way I felt”Brian

    Service user comment of RAID service

    “She didn’t actually do off a tick box or whatever, I was able to have a conversation…yeah, I felt quite comfortable telling them what my circumstances were and obviously my symptoms ,she was happy, well no, not happy with it, but she was understanding with it… ” Nadia

    “It was only the RAID team that “got me” and it was what I needed at the time, I was in real

    trouble”David

    “It was a life saver, I was very mentally ill at the time and I was very vulnerable, I do see that could have gone and continued and just back to square one again…”Brian


    Of 205 staff replying to the raid evaluation questionnaires

    Of 205 staff replying to the RAID evaluation questionnaires

    • 97% of staff said that they were fully aware of the role and function of RAID

    • 97% believed that the RAID liaison service improves patient care

    • 97% believed that the RAID liaison service supports acute hospital clinical staff

    • 92% said that they would be keen to receive teaching and training on mental health issues by the RAID team

    • 95% said that they were satisfied with the response time of RAID during office hours


    Raid trials tribulations and evaluations

    “Thank you for all the times you have been and helped us down on MAU. You’re a valuable asset!”City Hospital Nurse

    “Brilliant service in A&E, fabulous staff. Patients able to see appropriate MH personnel quickly, negating long delays and increasing frustration” Heartlands Hospital Sister

    “Don’t know what we would do without them!”Queen Elizabeth Hospital Nurse

    “RAID is needed strongly within this trust”Good Hope Hospital


    Obstacles faced during this journey

    Obstacles faced during this journey

    • Clinician suspicion

    • Management suspicion

    • Several different Trusts debating the value/ benefits to themselves

    • Lack of integrated thinking

    • Lack of whole pathway thinking

    • Lack of whole person/ patient experience thinking

    • Still awaiting CEO signoff


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