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Acute Mental Health Discharge Pathway

Acute Mental Health Discharge Pathway 

   The aims of the project were:        

  • To reduce situations where patients are in acute psychiatric units longer than they need to be     

  • To ensure discharge processes are integrated as much as possible, so that planning by Hampshire County Council (HCC), Southern Health NHS Foundation Trust (SHFT) and the Clinical Commissioning Group (CCG) are proactive with actions undertaken in parallel, rather than being reactive and completing actions sequentially

  • To contribute to improved flow through the system and a more positive patient experience.   

From an original idea identified during a multi-organisational teleconference discussing patients whose discharge was delayed at Kingsley Ward, a Steering Group was established to scope and progress a Quality Improvement Project.  

The established Steering Group brought together key staff from each of the three organisations as well as a Patient Expert by Experience and a Governor from SHFT, independent to the process.

The Steering Group met regularly from July to September, leading up to the delivery of a week-long Rapid Process Improvement Workshop (RPIW) at the beginning of October 2019. 

The Rapid Process Improvement Workshop was jointly facilitated by SHFT and HCC. There were a total of 27 individuals who attended all or part of the workshop with an average daily attendance of 18.

The workshop was attended at key points by the project’s sponsors (from each of the three organisations), members of the SHFT Transformation Team (Communications, Patient Expert by Experience and the Clinical Director) and representatives from the HCC Contact, Assessment and Resolution Centre.   

Participants were invited to consider the current process and data and identified in excess of 100 ideas for improvement.  These were themed and four areas for further work were identified:

  • Opportunities on Admission – identified the requirement to begin the discharge process as close to the point of admission as possible, ensuring this included patients and carers, was based on assessed need and actions ran concurrently rather than a linear process

  • ‘Supporting’ Processes – examined the current processes that were deemed to be supporting the discharge process to reduce non-value added activity, waste and duplication

  • Rehabilitation – highlighted the need to identify the appropriate pathway earlier, based on identified need and reduce delays in accessing appropriate services whilst reducing waste, duplication of effort and unnecessary actions

  • The ‘Funding’ Panel – identified need to improve understanding of the function of the panel, reduce bureaucracy, waste and unnecessary effort with the aim of ‘getting it right’ first time.

There were a number of successful outcomes from the project:

  • Opportunities on Admission - development of fortnightly drop-in sessions (Dorothy’s Drop-in) facilitated by the HCC Specialist Accommodation Officer, initially trialled in Kingsley Ward and subsequently rolled out to the two other Acute Mental Health Wards in Hampshire

  • 'Supporting Processes' - The twice weekly Management Flow Update Call where Senior Managers and clinical staff discussed flow through the ward and delays, has been ceased and replaced with the commitment by the multi-disciplinary team (MDT) to maintain information on the RiO (Electronic Patient Record) Patient Flow Record. This has released 80 minutes per person, per week (excluding preparation time) to reinvest in value added activity.  With at least 4 staff involved, this equates to a saving of a minimum of 320 minutes per week

  • Rehabilitation - there is a redesigned pathway for access to rehabilitation services based on early identification of need that links to applications for funding and other units’ referral requirements. Experience of use suggests that recent applications have been agreed at panel without any need for amendments 

  • The Funding Panel - the application forms for panel have been redesigned by a multi-professional group using a 'home first' and more person centred approach.     

You can read about the project outcomes in more detail by downloading the project closure report on the left.     

December 2020 Project Update
The Quality Improvement (QI) project focussing on inpatient acute mental health discharge pathway has continued to demonstrate lasting success. Although the group were unable to meet for their project celebratory event and six month review the data speaks for itself. The average length of patient stay on Kingsley Ward at Melbury Lodge has halved over the last two years and out of area placements have been eliminated. The latter is so helpful to a patient’s recovery, allowing the individual to remain in a familiar environment and close to family and friends. The project has also had a positive impact on relationships both between colleagues at SHFT and also across other organisations. The project team are hoping to meet in February, albeit virtually, for a post project closure review.
The most recent data can be found by downloading the document on the right.
If you would like any further information about the project please contact project facilitator Paul Thomas at paul.thomas@southernhealth.nhs.uk.
Participants in the project have reported that spending focussed time together has led to improved relationships, promoting a better understanding of each other’s roles.  It has enhanced the knowledge of who to go to and has broken down barriers in using each other’s expertise.  Participants have grown their portfolio of contacts and have reduced their reluctance in asking for ideas and help from others.
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