Developing a framework for admission and discharge: a nurse‐led initiative within a mental health setting

Abstract

Admission to a mental health inpatient setting is one important aspect of care which requires collaborative working between Community Mental Health Teams (CMHTs) and ward staff. However, links are not always formalized. The failure of effective gatekeeping coupled with inconsistent admission and discharge practices further complicates the situation for all those involved. A number of local changes, for example, adoption of a centralized bed bureau, together with policy changes, initiated a nurse-led practice development project. It was predicted that by creating a framework for more formalized communication between the different disciplines admission and discharge processes would be improved, thus enhancing service users' satisfaction and empowering all staff participating in the process. During the project, 132 service users were notified as potentially requiring admission. Admissions were avoided and diverted for 22 of them. The quality of the communication and information shared between the CMHTs and ward staff was significantly improved. Accessing inpatient beds, at times still remained problematic, as beds could only remain ring-fenced on 65% of occasions. This initiative, conducted within a 'real world setting', showed that it is possible to improve admission and discharge practices by creating a framework for a formalized communication process between disciplines.

Productive Ward initiative promotes better communication between mental health teams and ensures timely discharge for patients

“…Good communication and information sharing concerning admission and discharge is therefore imperative if effective collaborations between community and inpatient staff are to become a reality (Fiddler et al . ).…”

Once‐a‐week psychiatric ward round or daily inpatient team meeting? A multidisciplinary mental health team's experience of new ways of working

“…Staff in a 20-bed, generic, acute psychiatric ward in north-west England decided to reform the prevailing structure of the once-a-week, 'traditional' ward round described earlier. This project was linked to a 2-year study into gatekeeping (Fiddler et al 2007) and took place over 16 months. The ward had a bed occupancy level of 110-120% and a high number of delayed discharges, making it difficult for the two community mental health teams (CMHT) within the city-wide mental health trust to gain timely admission for high-risk patients.…”

“…Staff in a 20‐bed, generic, acute psychiatric ward in north–west England decided to reform the prevailing structure of the once‐a‐week, ‘traditional’ ward round described earlier. This project was linked to a 2‐year study into gatekeeping (Fiddler et al. 2007) and took place over 16 months.…”