Mental Health in the A&E

Stompbox

I'm currently conducting research into the barriers to equity of response to physical and mental health presentations to the Emergency Department in Beaumont and was hoping I could collect some insights from healthcare workers who might have a bit more direct contact with the ED than myself.

The Emergency Medicine Programme outlined a six-hour time standard for processing attendees to the ED, within which time 95% of patients should be either admitted or discharged. A recent spot-check in the ED of Beaumont Hospital revealed that only 15% of mental health patients (the focus of my research) were being discharged within the six-hour standard. My research involves processing a lot of raw data but I'd like to know a bit more about the potential reasons as to why the standard isn't being adhered to. Is there anyone here who might have a bit of insight that they could offer me? Thanks in advance!

Vorsprung

Psych won't see patients until they're medically cleared, so if you take a quick example of someone who has taken a handful of tablets (paracetamol is a good example) and bloods need to be done at 4 hours post ingestion, so clearance can't be done till those levels are back. Add many more hours if the patient is drunk. So when deemed medically cleared for psych review, they may not be seen until some time after that, and because a psych review (including phone calls to relatives/GPs) can take at least an hour (and add more to that if you're trying to get a patient admitted).

Secondly, Beaumont isn't neccessarily reflective of most EDs, I believe their figures aren't great in general.

I haven't read the EMP in its entirety, but while it has some great targets and ideas, the speciality for which it is written struggles to attract and retain good doctors amongst its ranks due to lack of funding/support and morale (I'd suggest lower morale than other hospital specialties).

Sam34 will give another perspective on this! Mine is an ED view, though I have never worked in Beaumont.

Truman Burbank

Hi!

- The large acute EDs tend to have (should have) full-time psychiatric Clinical Nurse Specialists assigned solely to The ED. 1 FTE
- These CNS IIs normally work Mon - Fri 8am - 5pm
- There is no such service for weekends and BHs/PHs that I am aware of
- I do not know if there is AL leave cover (1 FTE would have around 6wks/year)
- CNS II should be at 8am handover with consultant and departing/starting medical staff, they do not normally attend 4pm handover
- There should be 1 FTE MSW in The ED, who works closely with the CNS II (this is key)
- Good access to community services/OPD/homeless services etc (Key x 10)
- There is also a Liaison Psych NCHD assigned to The ED, who is contacted (in the first instance) by The CNS II
- This pathway is gone 'after-hours'; Excluding the initial ED NCHD/consultant assessment, all the ground-work has to be done by the Psych NCHD, who could also be assigned to 'The Main Hospital' Psych Unit
- A number of patients are frequent attenders, who are known to the CNS/MSW, but not normally to the ever changing Psych NCHDs (some exceptions obviously)
- Look at The Department's DSP data, for example, for an idea of presentation times (they have probably done this in detail)
- Some patients cannot be discharged because there is no-one to collect them if that is required
- Some patients do not want to be discharged
- Some relatives do not want the patient to be discharged
- Staff cuts
- Medical clearance as above

RobFowl

I work in Beaumonts catchment are and most psych referral by pass Beaumont. Although not very fas, urgent psych OPD referrals would be better and emergencies/admissions go via Joyce rooms in St Vincents, Fairview.
Would be interested to see the results of your research when finished or while progressing.

Stompbox

Thanks a lot for the input, guys; I very much appreciate it.

I'll be sure to update you on my progress.

Truman Burbank

Stompbox wrote: »

Thanks a lot for the input, guys; I very much appreciate it.

I'll be sure to update you on my progress.

You would, I assume, have met with an ED consultant starting this out. They will give you direction/further clarification. Win-win. Best of luck!

Lunafizzle

This sounds like very interesting research Stompbox, I would love to see the end results! Just a quick Q (if I could be so bold! ) what perspective/background are you coming from? Medical? Sociological? Psychological?

Anyways, the very best of luck with your study, I hope you find some very interesting results!

Stompbox

Truman Burbank wrote: »

You would, I assume, have met with an ED consultant starting this out. They will give you direction/further clarification. Win-win. Best of luck!

I've linked in with an ED consultant who's acting as my supervisor. They've been extremely helpful but I just thought I'd post this here so I can collect as many insights as possible.

Lunafizzle wrote: »

This sounds like very interesting research Stompbox, I would love to see the end results! Just a quick Q (if I could be so bold! ) what perspective/background are you coming from? Medical? Sociological? Psychological?

I'm a third year medical student and I'm conducting a clinical audit as part of a six-week elective. I'm really enjoying it so far, I think Psych is the one for me!

Lunafizzle

Stompbox wrote: »

I'm really enjoying it so far, I think Psych is the one for me!

Hooray! Best of luck with it Stompbox

Vorsprung

Fair play.

If you can, send it around to a couple of journals when it's finished, it would be good for your own development and always nice to have it on the CV when it comes to applications in years to come. I'm sure your supervisor will fill you in.

Truman Burbank

Stompbox wrote: »

Thanks a lot for the input, guys; I very much appreciate it.

I'll be sure to update you on my progress.

OP, the time has come to update us.......

sillymoo

Yes I would also be interested in an update on this especially after seeing this story today:
http://www.rte.ie/news/2014/0518/618159-beaumont-hospital-shane-oneill/