High Intensity User Quality Improvement Project

Abstract

AimsTo ensure that patients who are high intensity users of acute mental health services (136 suite, Liaison, and inpatient admissions) have a ‘safety plan’ in place .This should contain person centred and specific recommendations to avert crisis and guide acute clinicians in managing care in a crisis situation.MethodsAudit of electronic health care records of top 10 patients who most frequent attend each of s136 suite, LPS and inpatient wards (26 in total) in the period 05/2021 to 04/2022.Process mappingDriver diagramCoproduction via patient engagement teamFocus group-across care groups and lived experienceResults-Audit of 26 identified HIU – whilst most (>80%) had a ‘safety plan’ in place, these lacked sufficient detail to avert ‘crisis’ and guide appropriate treatment should the situation escalate. The most frequent diagnosis was EUPD (77%). Most (93%) were open to CPA pathway. •Process mapping – visual representation of crisis planning process within CPA process.•Driver Diagram – primary and secondary drivers leading to change ideas of: additional ‘HIU response plan’ template; best practice example to guide care coordinators; process of flagging up HIU to community mental health services.•Focus group – themes included the importance of : joint working across care groups’ transparency with patients regarding professional opinion; consistency of interventions during a ‘crisis’; and coproduction of safety plans.•HIU response plans are incorporated into the safety plans of 20/26 HIUs.•PDSA process ongoing – quality assurance and clinical effectiveness of changes to be reviewed. Further change ideas sought through QI process.ConclusionHigh intensity users who often present in ‘crisis’ to acute mental health services, have unmet needs.This cohort require an additional framework to meet their needs.When patients experience a mental health ‘crisis’, a consistent and clear treatment response is experienced as helpful.Safety/crisis planning is thus an important aspect of meeting needs.HIU response plans’ can be incorporated into a patients ‘safety plan’ to ensure that individualised and specific guidance is available.Best practice example of ‘HIU response plans’ can empower community mental health colleagues to co-produce such plans.