Teesside Liaison Psychiatry 24 hour working – a clinical perspective Dr Matt Rowett & Dan Sanderson

Or… What’s is actually like to work in a 24 hour Liaison service?

This session will not… Tell you how to set up 24 hour Liaison Psychiatry Tell you which model is right for your hospital

This session aims to… Give you an insight into what it’s like for the staff working in a 24 hour Liaison service Start you thinking about some of the positives and some of the pitfalls when developing a 24 hour service Learn from our experience

Background Previously 4 different teams Three different hospitals Different working hours Different contact numbers Different disciplines

Flexible rapid assessment The aspiration Flexible rapid assessment Specialist adult team Specialist Older peoples team

Staff Psychiatrists Psychologists OT’s Support workers Associate Nurse Consultants Band 6 nurses

What’s it like working in a 24 hour team? “Its hard work, busy, exciting, daunting. If you want an easy job liaison is not for you. Its good being on the 'sharp end' and being part of a busy general hospital that opens 24 hours” “Challenging due to variation of referrals and amount of referrals” “It's hard for staff who specialise in one area to adjust and there should be dedicated specialised staff for older person and ones for adult, staff turn over would be lessened”

“Varied specialist input from all liaison professionals is always interesting. There’s always something different happening and something new to learn. A 24 hr approach enables a wider opportunity to glean varied information about the patient and enables families to be seen easier”

What are the advantages? Very quick assessment Increases our confidence and decision making Timely response. Signposted to a service to meet their needs. Autonomy. Assessments are not batched. There is a flow of work throughout the 24 period and appropriately responded to Timely, shorter patient stays, less waiting times, earlier treatment and advice, being there for people

What are the disadvantages? Elderly patients are not priority due to the turnover of the adults . They have very little continuity of care due to the shift system I hate nights! Difficulty in recruiting and retaining staff constant turnover of new staff whom need inducting the elderly are not receiving as good as service as they could Also I don’t believe that the team attracts the right standard of elderly nurses as they are reluctant to apply due to working with adults

Too diverse, too busy at times, quality of documentation , can be challenging working alone at night. lone working on a night shift the work can be demanding particularly if there is only one night nurse and there have been a number of patients overnight. Sometimes patient need more time in a safe environment out of their reality to get things into perspective.

If you could give a team who was about to go 24 hours any advice what would it be? Try to focus on the positives that the service can offer , it has to be an improvement offering 24 hours to patients two staff on nights and extra staff on weekend as it's just as busy at the weekend

Continue to believe in what you are doing Continue to believe in what you are doing. It is difficult at first but once the process / routine is embedded the benefits are there. Ride the storm as the good outcomes for patients speak for themselves Remember although you are working alone you are not alone, utilise the support of other teams such as liaison teams and crisis teams for clinical support.

What is the single best thing about working in a 24 hour Liaison team? Timely specialist interventions for patients Patient centred service- their needs Knowing we are providing a better service and having the flexibility with shifts and earning more money for unsociable hours!

If you had one wish about how the service could change what would it be? I would wish that all staff within Liaison worked 24 hours to make it a 24 hour service Liaison Discharge support to facilitate earlier discharge where appropriate. More staff to meet the demands and to be able to focus upon quality initiatives.

What's it like going from a 9-5 or extended hours team to working in a 24 hour team? Daunting, over whelming, but the outcomes are worth the it. Its the right thing to do for the patients and acute trust staff!!!! A feeling that patients are left in safe hands there is always someone there to care for their mental health.