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Joan Blackwood Clinical Lead MH Service Re-design Frances Paton

Joan Blackwood Clinical Lead MH Service Re-design Frances Paton Business Intelligence Manager (Partnerships) Fiona McMahon Senior Practitioner, Re-admissions/Service Improvement. “Improving Care Delivery and the Patient Experience”. The A&E and Mental Health Pathway.

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Joan Blackwood Clinical Lead MH Service Re-design Frances Paton

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  1. Joan Blackwood Clinical Lead MH Service Re-design Frances Paton Business Intelligence Manager (Partnerships) Fiona McMahon Senior Practitioner, Re-admissions/Service Improvement

  2. “Improving Care Delivery and the Patient Experience” The A&E and Mental Health Pathway

  3. 2010/2011 GG&C Performance and Development Plan – Contribution to Acute Services Framework (HEAT 10) GG&C A&E Attendances Steering Group GG&C MH and A&E Acute Interface Working Group (Lead - Calum MacLeod Head of Mental Health South Glasgow) Background

  4. Multi disciplinary and management representation from A&E, Mental Health, Addictions, A&E Attendances Group, Homelessness, Liaison, Information Services etc. 4 hour breaches + reasons Repeat attendances Clinical Pathways Clinical Sub Group MH and A&E Acute Interface Working Group

  5. Information Areas that need to be explored - those with common causes for delay • Wait for 1st Assessment • Wait for Specialist Assessment • Wait for Psychiatric Bed • Wait for Transport

  6. Greater Glasgow & Clyde – Phase 1 • Identify patients who are A&E Breachers • Identify all A&E attendances who have a MH diagnosis and are known to our services. To do this we - • Extracted all Mental Health A&E presentations. (North & South A&E – not Clyde) • Extracted all MH data recorded on PIMS (Inpatient, CMHT, Crisis etc). • Merged into one database to identify patients. (Patient Linkage) • Resulted in ‘draft’ suite of information reports linking in with Service use .

  7. Snapshot of Information Reports (Period: 01/10/2009 – 31/03/2010) Last known MH Service prior to A&E presentation Presentations where A&E Diagnosis is Categorised 7,057 MH presentations, CHI present in 6,296 (4,864 patients) so Reports are based on these 6,296 records • Better use of information to help inform decision making.

  8. Snapshot of Information Reports Associated CMHT’s for Patient • Better use of information to help inform decision making.

  9. CLINICAL PORTAL • What is Clinical Portal? • A web-based system that presents all electronic information for a patient in a single location • The Portal uses technology to provide a clinician-friendly view of information from multiple information sources. • Mental Health data on Clinical Portal • Data items to be published in the Mental Health clinical Portal are: • Alerts • Open Referrals • Diagnoses • Last Contact • Last Clinic Attendance • Mental Health Sparra on Clinical Portal • Predictive algorithm, developed by ISD. It identifies patients aged 15 years and over at risk of re-admission to a psychiatric hospital or unit.

  10. CLINICAL PORTAL – Mental Health PIMS

  11. CLINICAL PORTAL – Mental Health PIMS

  12. CLINICAL PORTAL – Mental Health SPARRA

  13. CLINICAL PORTAL – Mental Health SPARRA

  14. Next Steps • ‘Work in Progress’ • Consolidate and agree information requirements between services • The initial information analysis has prompted questions about Clinical Pathways between A&E and Mental Health including Addictions

  15. As a result of the data collection exercise reports can now be made available to highlight : Patients who are known to both A&E and Mental Health Services Are regular attendees at A&E Regularly breach the 4 hour target Mental Health, A&E & Addictions Patient Pathway

  16. We needed to gain a better understanding of the patient journey. To identify gaps, blocks, delays, demand and capacity issues across services. Most importantly we wanted to know what was happening to patients. But

  17. Sub-Group established included clinical staff from : A&E, Adult Community Mental Health, Crisis (day & night OOH) Liaison Psychiatry, Inpatients and Addictions Remit of Group: To carry out a process mapping exercise to accurately inform routes into and out of A&E To test clinical scenarios across the process map and identify current systems To support effective interface across all services Mental Health, A&E & Addictions Patient Pathway

  18. Three meetings – task and finish approach Plan – scope and range of the work Process map – involving all stake holders Follow up issues identified and action plan developed Process

  19. Feedback Progress – MH and A&E Acute Interface Working Group, GG&C Attendances Group Four dimensions to the action plan – Clinical Practice Information Service Response Patient Experience Extend membership of Clinical Group to reflect the further work required on pathways Next Steps

  20. Information – Using information to help inform and improve clinical practice. Clinical Portal – A&E Staff will have access to Mental Health Service Data. Clinical Response – What is the expected response by A&E and Mental Health Staff. Develop Clinical Practice Guidelines – to access management/crisis plans, develop case review mechanisms. Service response – further work to be done with other parts of the Mental Health Service i.e. Addictions Action Plan – “A Taster”

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