Project AIMS: Improving Access to Adult Inpatient Mental Health Services in Northern NSW

Patients that require access to mental health inpatient units may experience prolonged wait times when attending the emergency department (ED). This can be associated with higher rates of morbidity and mortality, and increased rates of aggression and absconding.¹ Project AIMS looks to improve front-door patient flow processes for adult mental health consumers seeking or requiring access to acute mental health inpatient services in Northern NSW Local Health District (NNSWLHD).

This project focuses on streamlining operational inefficiencies, standardising admission processes between sites, reducing clinician-dependent variation, and enhancing the patient experience. Diagnostics revealed inefficiencies in the admission process from ED. For example, a lack of clarity in roles led to high phone traffic and confusion about decision making responsibility. ED and Mental Health teams had limited understanding of each other’s areas leading to a lack of cooperation and disagreements.

A busy ED environment meant that there were delays in transferring patients from ED to the ward due to competing priorities. Inconsistency in the timing of mental health assessments in ED caused delays in when a patient is considered ready to leave ED. This resulted in clinical variation that reduces the safety and quality of care provided, caused frustrations for staff, which ultimately creates a potentially confusing and unpredictable reception of care for our consumers.

New process aligned with trauma informed care

One of our key implementation achievements is changing the ED to Mental Health transfer of care process. Now, mental health nurses from the receiving inpatient unit attend ED to greet the patient, receive bedside handover, and escort the patient to the ward. This practice is more in line with trauma informed care, as it strengthens the relationship with receiving ward staff and improves clinical safety in transfer of care, as mental health nurses can visually review the patient and identify issues before departure from ED. Another benefit is a greater appreciation between ED and mental health clinicians, and a shared dedication to improve the patient journey and the overall functioning of the hospital.

We have successfully standardised early mental health assessment in ED, reducing the need for patients to wait for an ED medical officer review (where clinically appropriate). Introductions are made, and assessments are commenced as quickly as possible, which means an admission or discharge determination can be made earlier.

Changes in mental health patient flow processes are ongoing, with work being undertaken to optimise communication and coordination between the ED and the Mental Health Operational Nurse Manager and their team. A Mental Health Patient Flow Committee has been established to conduct work clarifying admissions procedures, use of the Electronic Patient Journey Board and FirstNet icons between sites and establishing a Model of Care for mental health patient flow.

Our project was impacted by limitations and barriers, meaning some solutions were not able to be successfully implemented. Some of these barriers include reduced time resourcing for project leads, no established consumer engagement or participation in the Mental Health service, Tweed Valley Hospital relocation, and the unreliability of data sources.

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