Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants

Wand, Timothy; D’Abrew, Natalie; Acret, Louise; White, Kathryn

doi:10.1016/j.ienj.2015.05.003

Cited by 30 publications

(38 citation statements)

References 14 publications

(15 reference statements)

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“…Some EDs have mental health and/or addiction services located within the ED. While services such as these vary in their operational timeframes from 16/24 h (morning and evening services), to nightshifts or approximately 20/24 h, they have shown to be effective in expediting and enhancing assessment and referral services, improving inter‐disciplinary relationships and providing positive patient experiences as well as health outcomes . With our study indicating that many ED presentations BIBP occur after‐hours, ensuring similar services cover this period is pertinent.…”

Section: Discussionmentioning

confidence: 86%

Characteristics and outcomes of patient presentations made by police to an Australian emergency department

Crilly

Zhang

Lincoln

et al. 2019

Emerg Medicine Australasia

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Objective: To describe and compare characteristics and outcomes of patient presentations brought in by police (BIBP) with those not BIBP (NBIBP) to one Australian ED. Methods: A retrospective observational study. All patient presentations to a tertiary hospital ED made during the period 8 October 2012 to 7 April 2013 were included. Routinely collected ED information data and medical record review data were used. ED care delivery for people BIBP from the watch house (WH) or other location was compared. Univariate comparison and multivariate logistic regression analyses were performed to identify the different characteristics and ED outcomes between BIBP and NBIBP groups. Results: A total of 35 127 ED presentations occurred within the 6 month period; 392 (1.1%) were BIBP. Compared with those NBIBP, those BIBP were diagnosed with 'psychiatric' and 'toxicology-related' illnesses in higher proportions. Overlap in health conditions (primarily for physical health reasons) between those BIBP and NBIBP existed. Presentations BIBP from the WH reflected 'physical health emergencies' whereas presentations BIBP from other locations reflected 'behavioural emergencies'. Compared to those NBIBP, those BIBP had a longer wait to be seen (by about 5 min), longer ED length of stay (LOS) if not admitted (by about 20 min) but shorter ED LOS if admitted (by about 59 min). When adjusted for sex, age group and diagnosis, ED LOS (if admitted) and admission rate were statistically significant. For those BIBP, mental health related orders and alcohol breath tests were common. Conclusions: Patients BIBP were different to those NBIBP. Despite comprising a small proportion of overall ED attendances, they are a group where mental health and drug and alcohol issues are over-represented. Differences in ED care delivery for those BIBP highlights potential opportunities for pre-hospital healthcare interventions.

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Section: Discussionmentioning

confidence: 86%

Characteristics and outcomes of patient presentations made by police to an Australian emergency department

Crilly

Zhang

Lincoln

et al. 2019

Emerg Medicine Australasia

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“…Examples of these models include FastTrack areas for patients with minor injuries, observation units, rapid assessment teams, allied health models and nurse practitioner (NP) services. 2 Although there are reports in the literature of the evaluation of the effectiveness of some of these models, 10,11 there is scant evidence to inform ongoing service planning. Furthermore, there is no published work on the uptake of these models, nor is there widely available information on current workforce profiles in EDs.…”

Section: Introductionmentioning

confidence: 99%

Mapping workforce configuration and operational models in Australian emergency departments: a national survey

Gardner¹,

Gardner²,

Middleton³

et al. 2018

Aust. Health Review

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Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs. Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study. Telephone interviews were conducted with nursing or medical department managers to collect data related to hospital characteristics, ED workforce and training and ED service and operational models. Results Surveys were completed in 87% of the population sample (n=135). Metropolitan EDs were significantly more likely to retain higher full-time equivalents (FTEs) in several medical (staff specialist, registrar, resident and intern) and nursing (nurse practitioner (NP), nurse educator, nurse unit manager and registered nurse) positions. NPs were employed by 52% of Australian EDs overall, but this ranged from 40% to 75% depending on jurisdiction. The most commonly used operational models were FastTrack teams (72% of EDs), short-stay/observational unit (59%) and patient liaison models for aged care (84%) and mental health (61%). EDs that employed NPs were significantly more likely to use FastTrack (P=0.002). Allied health services most frequently available within these EDs were radiology (60%), social work (69%), physiotherapy (70%) and pharmacy (65%). Conclusions The present study has established a baseline measure of the staffing configuration and organisational characteristics of Australian EDs. What is known about the topic? EDs are overcrowded due, in part, to the combined effect of increased service demand and access block. Innovative service and workforce models have been implemented by health departments aiming to improve service and performance. National uptake of these service and workforce innovations is unknown. What does this paper add? The present study is the most comprehensive to date profiling Australian EDs covering hospital characteristics, workforce configuration, operational models and NP service patterns and practice. What are the implications for practitioners? Information from the present study will assist health service planners to evaluate workforce and service reform models, and to monitor trends in emergency service development.

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“…To our knowledge, these results have not been previously reported, suggesting that the frequency and type of help received responded adequately to patient needs and improved their MH conditions. Studies on innovations similar to those of the brief intervention team have reported decreased symptoms [26], suicidal behaviors [22,34] and psychosocial problems [46]. Since most patients (61%) were given MH referrals following the brief intervention, it may be hypothesized that these referrals were adequate and that MH network functioning was effective [62,63].…”

Section: Aggressive or Overly Critical Family Membersmentioning

confidence: 99%

“…Certain patients were difficult to engage, such as those with personality disorders or SUD [16,23]. Concerning the impact of ED innovations, reduction in costs [25,31,32], ED wait times [33][34][35], ED use [6,15,35] and hospitalization rates [16,18,36] were most often cited, regardless of intervention type, while the adequacy of referrals generally improved [27,37,38] in brief intervention and peer-user support services. In terms of health outcomes, patient symptoms decreased for the three intervention types [25,26,36].…”

Section: Introductionmentioning

confidence: 99%

Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study

Gabet

Grenier

Cao

et al. 2020

BMC Health Serv Res

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Background Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. Method Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. Results Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. Conclusions Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.

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Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants

Cited by 30 publications

References 14 publications

Characteristics and outcomes of patient presentations made by police to an Australian emergency department

Characteristics and outcomes of patient presentations made by police to an Australian emergency department

Mapping workforce configuration and operational models in Australian emergency departments: a national survey

Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study

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