AT A GLANCE
THE CHALLENGE
The trust was looking to enhance the care of patients in need of emotional wellbeing support who were waiting a long time in the emergency departments (ED) at Calderdale Royal Hospital (CRH) and Huddersfield Royal Infirmary (HRI).
The ED environments were considered not supportive enough for people in crisis, both in terms of noise and layout. Staff were seeking more specialist mental health training to support patients. Increased collaboration was needed with South West Yorkshire Foundation Trust (SWYFT), the main provider of mental health services who provided good assessments and planning but faced capacity challenges to implement the changes effectively. The project also sought to explore improving inpatient care for young people in hospital waiting for Child and Adolescent Mental Health Services.
WHAT THEY DID
The national CLEAR team conducted a 26 week transformation programme working closely with colleagues at the trust – interviewing 22 staff across seven organisations and speaking to service users. Their feedback was combined with in-depth analysis of 4,567 ED attendances to identify key challenges and develop new ways of working.
CLEAR RECOMMENDATIONS
The project team recommended that the Mental Health Liaison Team (MHLT) in the ED be expanded to enable patients’ physical and mental health to be assessed at the same time and to identify complex patients earlier – with a member of the team in the ED at all times to support patients in acute crisis.
It suggested the creation of a new mental health support team to provide one-to-one care in the ED as well as support admissions and discharges. Other recommendations included extra training for ED nurses and for the department to be made more welcoming with dedicated cubicles for mental health patients including one for children and young people. A separate mental health ED could be considered as part of the trust’s future plans.
The team also recommended that the trust work with its healthcare partners to analyse the reasons for repeat ED attendances and seek to find better ways of caring for those patients in the community.
FORECAST IMPACT
The quality of care and experience for some of the trust’s most vulnerable patients would improve with reduced waits in ED. There would be more joined up assessments between the mental health liaison team and ED staff. Patients would be admitted or signposted to other services more quickly and the most acutely unwell would be identified earlier.
The recommendations would lead to better collaboration between the trust and SWFT with more support and training for ED staff. ED and ward staff would see a reduction in workload and stress – with more time to focus on other patients.
Potential savings of £429,528 could be achieved by reducing hospital stays by one day with more discharge support – with 706 bed days saved – and less use of agency staff to provide one-to-one care for patients in the ED.
