Joan Blackwood Clinical Lead MH Service Re-design Frances Paton Business Intelligence Manager (Partnerships) Fiona McMahon Senior Practitioner, Re-admissions/Service Improvement

The A&E and Mental Health Pathway “Improving Care Delivery and the Patient Experience”

Background 2010/2011 GG&C Performance and Development Plan – Contribution to Acute Services Framework (HEAT 10) GG&C A&E Attendances Steering Group GG&C MH and A&E Acute Interface Working Group (Lead - Calum MacLeod Head of Mental Health South Glasgow)

MH and A&E Acute Interface Working Group Multi disciplinary and management representation from A&E, Mental Health, Addictions, A&E Attendances Group, Homelessness, Liaison, Information Services etc.  4 hour breaches + reasons  Repeat attendances  Clinical Pathways  Clinical Sub Group

Wait for 1st Assessment Wait for Specialist Assessment Wait for Psychiatric Bed Wait for Transport Areas that need to be explored - those with common causes for delay Information

Greater Glasgow & Clyde – Phase 1 Identify patients who are A&E Breachers Identify all A&E attendances who have a MH diagnosis and are known to our services. Extracted all Mental Health A&E presentations. (North & South A&E – not Clyde) Extracted all MH data recorded on PIMS (Inpatient, CMHT, Crisis etc). Resulted in ‘draft’ suite of information reports linking in with Service use. To do this we - Merged into one database to identify patients. (Patient Linkage)

Snapshot of Information Reports (Period: 01/10/2009 – 31/03/2010) Better use of information to help inform decision making. Last known MH Service prior to A&E presentation Diagnosis categoryCount% Alcohol1,88042% Drug1,24027% Psychiatric / Other1,08624% Self harm (no drug / alcohol)3137% Total:4,519 Presentations where A&E Diagnosis is Categorised Known to Mental Health ServicesKnown to Adult CMHT Presentations%Patients%Presentations%Patients% 3, ,64442%107141% 7,057 MH presentations, CHI present in 6,296 (4,864 patients) so Reports are based on these 6,296 records Last Known Service Prior to A&E PresentationPresentations % of Total Known Prior to A&E Presentation Inpatient57536% CAT Team40225% Adult CMHT33321% Addictions Team1228% Crisis Team644% Liaison Team493% Esteem231% PCMHT201% Homeless111% Other70% Elderly CMHT40% Total Known to Service Prior to A&E Presentation %

Snapshot of Information Reports Better use of information to help inform decision making. Associated CMHT’s for Patient Unique% of Total Number of Patients with this amount of Presentations Linked CMHTPatients Presentations Arran - Known1315%1965% Arran – Not Known27811%45012% Arran Total40916%64617% Riverside - Known1606%2316% Riverside - Not Known1476%2125% Riverside Total30712%44311% Springpark - Known984%1785% Springpark - Not Known1777%2526% Springpark Total27511%43011% Anvil - Known934%1454% Anvil - Not Known1456%1855% Anvil Total2389%3309% Shawpark - Known934%1574% Shawpark - Not Known1385%2296% Shawpark Total2319%38610%

CLINICAL PORTAL What is Clinical Portal? Mental Health data on Clinical Portal Mental Health Sparra on Clinical Portal  A web-based system that presents all electronic information for a patient in a single location  The Portal uses technology to provide a clinician-friendly view of information from multiple information sources.  Data items to be published in the Mental Health clinical Portal are: o Alerts o Open Referrals o Diagnoses o Last Contact o Last Clinic Attendance  Predictive algorithm, developed by ISD. It identifies patients aged 15 years and over at risk of re-admission to a psychiatric hospital or unit.

CLINICAL PORTAL – Mental Health PIMS

CLINICAL PORTAL – Mental Health SPARRA

Next Steps ‘Work in Progress’ Consolidate and agree information requirements between services The initial information analysis has prompted questions about Clinical Pathways between A&E and Mental Health including Addictions

Mental Health, A&E & Addictions Patient Pathway As a result of the data collection exercise reports can now be made available to highlight : Patients who are known to both A&E and Mental Health Services Are regular attendees at A&E Regularly breach the 4 hour target

But We needed to gain a better understanding of the patient journey. To identify gaps, blocks, delays, demand and capacity issues across services. Most importantly we wanted to know what was happening to patients.

Sub-Group established included clinical staff from : A&E, Adult Community Mental Health, Crisis (day & night OOH) Liaison Psychiatry, Inpatients and Addictions Remit of Group:  To carry out a process mapping exercise to accurately inform routes into and out of A&E  To test clinical scenarios across the process map and identify current systems  To support effective interface across all services Mental Health, A&E & Addictions Patient Pathway

Process Three meetings – task and finish approach Plan – scope and range of the work Process map – involving all stake holders Follow up issues identified and action plan developed

Next Steps Feedback Progress – MH and A&E Acute Interface Working Group, GG&C Attendances Group Four dimensions to the action plan – –Clinical Practice –Information –Service Response –Patient Experience Extend membership of Clinical Group to reflect the further work required on pathways

Information – Using information to help inform and improve clinical practice. Clinical Portal – A&E Staff will have access to Mental Health Service Data. Clinical Response – What is the expected response by A&E and Mental Health Staff. Develop Clinical Practice Guidelines – to access management/crisis plans, develop case review mechanisms. Service response – further work to be done with other parts of the Mental Health Service i.e. Addictions Action Plan – “A Taster”