PsychED for Kids

Summary

Aim

To provide young people aged 12-17 years with timely access to mental health assessments in the ED, with the aim of reducing avoidable admissions and length of stay in hospital.

Benefits

• Reduces staffing and security costs.
• Reduces avoidable hospital presentations of youth mental health clients.
• Improves timely access to mental health care in the ED.
• Increases client, carer and staff satisfaction.
• Enhances opportunities for staff training and development.
• Improves National Emergency Access Target ( NEAT ) performance and length of stay.
• Provides a streamlined model of care that is easy for staff to navigate.
• Reduces the need to deploy staff from other areas due to staff shortages.
• Provides better client outcomes, including continuity of care.
• Reduces distress and uncertainty for clients and carers.
• Builds confidence in the Youth and Family Mental Health Service.
• Achieves 100% compliance with national mental health standards, state and local policy and evidence-based practice.

Background

In 2014, 227 young people aged 12-17 years presented to Coffs Harbour Base Hospital with mental health concerns, including anxiety, depression, psychosis, self-harm and suicidal ideation. The rate of presentations for mental health clients in this age group had increased by 28% from the previous year.

Prior to the project, the waiting time in the ED for this group was considerable. NEAT rates at Coffs Harbour Base Hospital were 67.3% in 2014 and 68.3% in 2015. Young people were often placed in an isolated space with a security guard for up to eight hours, or remained in the ED overnight awaiting a mental health review. Of these, 32% were admitted to hospital voluntarily or scheduled under the Mental Health Act. The average length of stay for young people was 5.3 days, with much of this time spent awaiting psychiatric review, care planning or transfer to a more appropriate facility.

In 2014, feedback from young people, families and clinicians provided a catalyst for undertaking a clinical redesign project to improve the young person’s experience and provide mental health care that is timely, age-appropriate, least restrictive and according to best practice.

Implementation

• A flowchart was developed to simplify the process for mental health consultations in the ED.
• A cordless phone was provided to the clinical nurse coordinator, allowing them to provide a rapid response to emergency presentations.
• An acute assessment appointment schedule was implemented, which provided one quarantined assessment time-slot each day.
• A roster was developed to help clinicians attend booked appointment times.
• A change was made to the Cerner IT system, so that ED staff could schedule appointments directly with the Youth and Family Team in Coffs Harbour Mental Health service.
• Morning meetings were implemented to help manage workflow.

Project status

• Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

• April 2015 to April 2016

Implementation site

• Coffs Harbour Base Hospital, MNCLHD

Partnerships

• headspace Coffs Harbour
• Centre for Healthcare Redesign

Evaluation

The Project will be evaluated in June 2016 and again in June 2017. Patient experience trackers, staff surveys and clinical information systems will be used to determine the success of the project through a number of measurements, including:

• response times
• waiting times
• patient and carer experience
• access to psychological therapy.

Further reading

• Mid North Coast Local Health District. Mental Health Services: Clinical Services Plan 2013-2021. Richard Gilbert Consulting; 2013.
• NSW Ministry of Health. Youth Health Policy 2011-2016: Healthy bodies, healthy minds, vibrant futures. NSW Kids and Families; 2010.

Contact

Carrie Lewis
Clinical Nurse Consultant, Youth and Family Team
Coffs Harbour Mental Health
Mid North Coast Local Health District
Phone: 0412 582 986
carrie.Lewis@ncahs.health.nsw.gov.au