Bed availability in aged mental health units and the impact of Emergency Department presentations: an escalation plan

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Bed availability in aged mental health units and
the impact of Emergency Department presentations
an escalation plan

• Presenter
• John Baird
• Aged Persons Mental Health

National Mental Health Benchmarking Project 27
November 2008
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Aged Persons Mental Health Program

• Program consists of
• three acute inpatient units,(55 Beds)
• three aged psychiatry assessment teams
• and five residential accommodation facilities
• (4 high care and 1 low care facility).

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History

• Admission process.
• Aged persons presentation at ED.
• APMHP 08.00-16.30.
• Interface with each other and adult services.
• No escalation process

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Why an escalation plan

• Aging population Aged related Illness In
  aged accessing ED. In demand for inpatient
  beds.
• Structure of admissions to APMHP beds.
• ECATT interface with ED and APMHP.
• Adult services Escalation plan.
• Number of 24 hour breaches continuing.
• Impact on clinical Care.
• Cultural change a aged persons programme

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What did escalation mean

• DHS guidelines
• Minimise the formation of queues
• Traffic light system
• Escalation of actions
• Escalation ensure appropriate level of scrutiny
• Leave beds
• Held beds, absconders, medical treatment, EDM,
  residential beds, leave
•  

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Four components

• Traffic light escalation plan.
• 8.00-4.30 ED flowchart.
• After Hours flowchart.
• Residential Escalation.

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What did we want to achieve!

• A clearer interface between Emergency
  departments, Adult MH Services and
  APMHP(Including Residential Services).
• A consistent approach across services.
• Clarity of role for clinicians.
• LOS/ Patient flow project.
• Better consumer outcomes

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Data

• Taken from 2 timeframes
• 1st May-30th Sept 2007
• 1st May-30th Sept 2008
• Benchmark
• All patients admitted to all three services ALOS
  Slightly increased from 41-44 days over these 2
  periods.
• Admissions form ED
• 5 month period 07 20 admissions
• 5 month period 08 13 admissions

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Data continued

• No of 24 hour Breaches in ED
• 5 month period 07 3
• 5 month period 08 0
• Average LOS for those admitted from ED
• 5 month period 07 30 days
• 5 month period 08 24 days