Search results

The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services.

All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan.

The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan.

Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.

In total, 40% of the deaths of patients with learning disabilities have been classed as avoidable, and there is a known increased risk of harm while inpatients in hospital. This paper aims to look at the current experiences and treatment of people with learning disabilities within a general hospital setting to examine factors that affect their care.

A comprehensive literature search was conducted of primary research between 2013 and 2019 to evaluate what is known about the quality of care and treatment that learning disabled patients experience within a general hospital.

The research suggests that people with learning disabilities receive haphazard care in hospital settings, with inconsistent implementation of reasonable adjustments, insufficient arrangements to support family and other carer input, and poor knowledge of learning disability amongst hospital staff.

Previously, reviews focussing on hospital care have mainly focussed on access to health care rather than its delivery. This review has found evidence of significant failings in delivering care to this patient group, identifying a gap of knowledge in this field regardless of policies and laws already in place. There should be stricter monitoring of the Equality Act’s enforcement, along with improved and mandatory training for all general health-care staff. It is crucial that health-care professionals learn from mistakes to improve the care and experiences of learning disabled inpatients.

The purpose of this paper is to address the serious problems that people with intellectual disability face in getting their healthcare needs met in general hospitals by improving the training of general hospital staff.

Review of recent developments in models of service provision including the development of intellectual disability liaison nurses and the RAID model in liaison psychiatry.

There is much scope for intellectual disability liaison nurses and liaison psychiatry services to work together in staff training in general hospitals. There is a clear strategic role for both services in convincing the management of general hospitals to implement such training using economic and quality arguments.

The authors suggest a new model of working to improve the healthcare outcomes of people with intellectual disabilities through effective training of staff in general hospitals.

The Glasgow acute addiction liaison nurse service provides a unique service to patients with alcohol and drug issues who are admitted to general hospitals in the Glasgow City area. It offers guidance on withdrawal management, educates patients and staff and provides a facility to refer to appropriate community services. Since its foundation in 2005, patient referrals have increased by more than 3,000. Additionally, it has taken on a greater educational role and is more involved in research and evaluation.

The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared by other health professionals.

Using a mixed-methods design, the findings from a mental health commissioner workshop (n = 12) were used to construct a survey that was distributed to health care professionals using an opportunistic framework (n = 98).

Four key themes emerged from the workshop, which was tested using the survey. The importance of secure funding; a better understanding of health care systems and pathways; partnership working and co-production and; access to mental health clinical information in general hospitals. There was broad convergence between commissioners, mental health clinicians and managers, except in relation to gathering and sharing of data. This suggests that poor communication between professionals is of concern.

There were a small number of survey respondents (n = 98). The sampling used an opportunistic framework that targeted commissioner and clinician forums. Using an opportunistic framework, the sample may not be representative. Additionally, multiple pairwise comparisons were conducted during the analysis of the survey responses, increasing the risk that significant results were found by chance.

A number of steps were identified that could be applied in practice. These mainly related to the importance of collecting and communicating data and co-production with commissioners in the design, development and monitoring of liaison psychiatry services.

This is the first study that has specifically considered the challenges associated with the commissioning of liaison psychiatry services.

Consultation-liaison psychiatry (CLP) researchers have not yet developed accepted quality indicators to measure efficiency or effectiveness. The purpose of this paper is to combine objective and subjective quality indicators to assess hospital-based CLP service utilisation, efficiency and effectiveness.

Service utilisation rate was calculated over the service's first four years. Patient characteristics and objective quality indicators relating to response timeliness in 2012 were examined. Totally, 41 staff and 52 consecutive patients completed evaluation surveys to subjectively evaluate effectiveness.

The utilisation rate increased initially and then slightly declined to 1.03 per cent of all hospital admissions. In 2012, 91.5 per cent were seen on the same referral day and 99.4 per cent by the next day. The benchmark for urgent referrals was not met (77.4 per cent). Patients rated involvement with the CLP service a positive experience (90 per cent), but were less clear about follow-up plans (68 per cent). Staff believed that the service improved the patients’ hospital course (98 per cent) and was communicated well (93-95 per cent). Only 63 per cent agreed that relevant CLP education was provided and 76 per cent rated follow-up plans as clear.

This CLP service was evaluated by measuring utilisation rates, referral response timeliness and consumer feedback. Referral to contact time is a useful objective quality indicator but should be combined with subjective yet standardised measures surveying service recipients (patients and referring staff) to be comprehensive and meaningful.

The current project aims to draft an NHS and care provider joint working protocol for patients with learning disabilities as they transition between care and NHS hospital services. The purpose of this paper is to present the rationale behind a joint working protocol and the progress of the project to date.

Working in partnership, Basildon University Hospital and Estuary Housing Association have sought to investigate the experiences in hospital of the people they support with learning disabilities. This has involved ongoing work examining patient pathways from both a hospital and care provider perspective as well as engaging in discussions with key stakeholders. It is hoped that these insights will feed into recommendations to form the joint working protocol.

Current findings are limited as this paper presents an interim report on an ongoing project. Initial findings around positive joint working practices are detailed. An emerging recommendation around improved information sharing between health and care provider in acute hospital settings is also discussed.

It is hoped that the project will improve experiences of people with learning disabilities in hospital locally, while inspiring other hospitals and care providers to adopt a joint working approach at a wider level.

The purpose of this paper is to illustrate the difficulties patients with intellectual disabilities face when they present to a general hospital with ambiguous symptoms and highlights the importance of adequate training for general staff in caring for people with learning disabilities.

The authors describe the pathway of a person with a learning disability and mental health problems from A&E, through a general hospital, to discharge and the problems encountered in terms of diagnostic clarity and subsequent treatment.

Delay in recognising a psychiatric cause for his symptoms and wrongly attributing his symptoms to his learning disability may have led to a protracted admission and invasive tests.

Education of healthcare professionals and proactive liaison work can help improve outcomes for people with intellectual disabilities when they are admitted to generic services.

Older people (those aged over 65) occupy a significant proportion of hospital beds, with many suffering from depression, delirium, dementia, anxiety and other conditions. The mainstreaming of mental health liaison teams within general hospitals is therefore to be welcomed. Sally Ashton and Christine Carter explain that the journey towards productive collaboration can take time, but the results are worth it.