ACUTE CARE PATHWAY AND ALTERNATIVES TO ADMISSION

Transcription

1 ACUTE CARE PATHWAY AND ALTERNATIVES TO ADMISSION Sarah Biggs and Helen Dudeney - Crisis Assessment & Treatment Team Services Manager s Mary Dolan and Michelle Howitt

2 Overview of Acute Services North West population 310,000 North population 310,000 Crisis Team Albany Lodge Acute Assessment Unit Host Families Mental Health Helpline Psychiatric Intensive Care Unit South West population 260,000 Crisis Team Swift Ward and Wren Ward Acute Day Treatment Unit RAID (Rapid Assessment Interface and Discharge) Host Families Crisis Team Aston Ward Acute Assessment Unit (8 beds) RAID (Rapid Assessment Interface and Discharge) Host Families South East/ East population 350,000 Crisis Team Mymms and Welwyn Wards Acute Day Treatment Unit Host Families

3 Crisis services; description of model of care CATT: Provides a 24/7 acute assessment function to service users presenting in crisis. Works with people aged 18 upwards. Gate keeping role for acute inpatient services. Provides home treatment as an alternative to an inpatient admission. Facilitates early discharge from acute inpatient services. Works alongside the Acute Day Treatment Unit (ADTU) to support service users. Provides an out of hours Helpline to service users and carers. Supports and supervises Host Family placements. CATT staff work in the acute assessment unit on a daily basis. CATT workers are based in the two A&E s at night.

4 RAID RAID - Rapid Assessment Interface and Discharge Service Multi-disciplinary team of consultants, nurses, social workers and a psychologist. RAID aim is to deliver better quality care for people with mental health problems in the district general hospitals. With RAID, the speed of peoples recovery is improved, resulting in earlier discharge, and savings for the acute trusts.

5 RAID (continued) RAID has 3 elements : Rapid response to A&E (no longer than 1 Hour for face to face assessment). Assess, treat and support early discharge for mental health patients in the general hospital. Workforce development- rolling programme of mental health training to general hospital staff to support staff in delivering better health care to people with a mental health problem.

6 Acute Assessment Units

7 In 2010 Too many beds. HPFT Acute Adult Inpatient Services cost 10.3 million/year ( m). Target for efficiency savings from governments comprehensive spending review. 24hr Crisis Teams have shown a reduction in bed use. Better recovery outcomes. Other Areas to Improve Efficiency: Creating an Integrated Pathway. Increasing Alternatives to Admissions.

8 Acute Assessment Beds 72 hour crisis and assessment beds. Operates 7 days a week. 2 assessment units, one in Aston ward, Stevenage and one in Albany Lodge, St Albans. 8 ring-fenced virtual assessment beds within the 24 bedded ward.

9 The Mental Health Assessment Unit Prior to the implementation of the assessment unit, patients would typically have their care reviewed once a week at the consultant-led multidisciplinary ward round. Problems: Inefficient Not needs led Not responsive Decisions were delayed or put off

10 The AAU Approach All informal or section 2 admissions go into the AAU. All new patients are seen the next day by a Consultant and Crisis team worker to plan care and discuss obstacles for discharge. Carers and involved professionals are invited to these meetings. The Crisis Team worker carries out preliminary assessment prior to review to look at requirements for discharge or transfer, and highlight any issues, such as housing, support, family situation Crisis worker gets information, invites people in and initiates resolving practical issues.

11 The AAU Approach (continued) A decision is made within 72 hours:- Transfer to a treatment bed ADTU Crisis Team for home treatment Host family Discharge to community services Discharge back to the GP

12 Acute Day Treatment Unit

13 Acute Day Treatment Unit Provides an acute resource as an alternative to admission. As part of the acute Care Pathway it accepts referrals from the inpatient wards and CATT Operates 7 days week 2 across Hertfordshire, each serving half the county. Transport available if needed.

14 Aims Providing a high quality, effective alternative to inpatient admission. Facilitating early discharge. To be as effective as inpatient care. Improve service user satisfaction. Reduce inpatient bed occupancy.

15 What we do. Provide a safe and stable therapeutic environment. To provide support to acutely unwell people in a community environment. To support the service user to maintain connections with their local community. To provide an environment in which people can be actively involved in activities of daily living. Offer a non institutional alternative to inpatient care. Maximise recovery

16 The Model The model was new and unique to HPFT and originally piloted for one year, 2010 /11. It has evolved considerably over a period of 4 years, the approach to practice embraces the Principles of Recovery in and through a collaborative partnership between the client, health and social care professionals, families and significant others within the context of the individuals social contexts of living.

17 Team Structure and Management Post 1 Consultant Psychiatrist 3PA s 1 Associate Specialist Doctor Full time Grade Psychology 1 Team Leader Band 7 or equivalent 2 Occupational Therapists Band 6 2 Nurse Band 6 2 Nurse Band 5 1 Clinical Psychology Assistant Practitioner Band 3 1 Occupational Therapy Technician Band 4 2 Support Workers Band 3 1 Administrative Staff Band 3

18 Physiological; nutrition, health, relaxation Psycho-social interventions and education Psychological input formulations Assessments interventions Care Planning Occupational therapy (Mohost - Wellness Recovery Action Plans) plus other OT interventions Artistic and creative Interventions Physical health monitoring Coordination/ Collaboration Skills and abilities that inform and influence the model and approach to practice Medical symptom management and relapse prevention medication concordance therapy Risk assessment and management - positive risk taking Key working Social inclusion strategies and life skills

19 Successes It has enabled a 20 bedded Acute Admissions Ward to be closed which has resulted in a reduction of acute admissions and created a saving for the Trust. Increased flexibility and options for acutely unwell service users and their families. Received excellent service user feedback. There has been a reduction in the length of stay on the wards, a reduction in the occupied bed days.

20 Service users central within its operation. Gained several Awards for its outstanding Customer Service and staff achievements. A new Acute Day Treatment Unit within the acute care pathway on the east side of the county has opened, another reduction of 10 beds.

21 Michelle's experience of being involved in the steering group

22 Host Families

23 Host Families A family that has been recruited to offer a supportive family environment to mental health service users as an alternative to inpatient care.

24 Provide a stable therapeutic environment. To provide support to individuals in a community environment. To support the service user to maintain connections with their local community. To provide an environment in which people can be actively involved in activities of daily living. Offer a non institutional alternative to inpatient care.

25 Responsibilities of the host To provide a home, care and support. To work with the guest and Crisis Team in developing and delivering a support plan. Ensure that the guest is treated with care and respect. Ensure that the basic needs of the guest (food, warmth, drink, safety, etc) are met. To inform the Crisis team of any concerns relating to the service users well being. To support the involvement of and access to the guests carer in line with the agreed Support plan.

26 Progress so far 8 Host Families have been recruited and inducted. 4 others going through recruitment process. 56 service users placed. Early evaluation very positive. Increased referral rates for Host Family placements as clinicians become confident in the scheme. HSJ award-innovation in mental health 2012.

27 Financial Benefits No need to recruit additional staff. Costs 600 per week in HF vs 2,100 in Acute ward. 2013/ placements averaging days. In patient day savings of 87k. Slow burn saving will increase.

28 Host Families Feedback I was happier talking to someone who will listen to you all the while. I would say that it saved me. It saved me from looking at the rest of the people on the ward. Having my own room, my food that I wanted and activities that I wanted to do. I could have had visitors but it was my choice not to To make my own bread, fruitcake etc was just nice, I enjoyed it. I started cooking for myself again instead of just getting chips..cooking s great therapy

29 Dean was asked, what were the benefits of being placed with a Host Family? It changed a lot of aspects of my thinking. You don t think you ll ever be in that situation [the ward]. All of a sudden you are in this deep big hole, and then when I was in the host family I was above ground. I was happier talking to someone who will listen to you all the while. I would say that it saved me. If I had left the ward and gone straight back home I would have deteriorated again, without a shadow of a doubt.

30 Any Questions or Comments