How effective are mental health nurses in A&E departments?

Abstract

Background: A&E departments are key points of contact for many people with mental health problems. Various models of care have been developed in A&E departments for delivering mental health services, but few have been assessed for effectiveness. The present study aimed to assess the impact of a dedicated A&E psychiatric nurse service on several outcomes relevant to patients and clinicians. Methods: A crossover design was used to introduce a dedicated psychiatric nurse service (comprising four experienced community psychiatric nurses) into two busy UK A&E departments. Standardised assessments were completed for each patient, and a random sample of these independently assessed for quality. Data were also collected on the number of patients assessed, psychiatric nurse time employed, waiting times, onward referrals, repeat attendances, patient satisfaction, and staff views. Results: A&E staff referred about a third of patients judged to have mental health problems to the psychiatric nurse service; approximately half of those assessed had a psychiatric history. On average, assessments took 60 min and over 90% of the formulated management plans were judged appropriate by independent assessors. The psychiatric nurse intervention had little impact on waiting times or satisfaction levels for mental health patients, although there was evidence of a change in onward referral patterns. Comment: Psychiatric nurse assessment services have been introduced in many A&E departments, although the evidence base for the effectiveness of this development is not well established. This study presents evidence that psychiatric nurses can provide an accurate assessment and referral service with advantages for patient care.

Enfermeiros De Serviços De Urgência E Emergência Psiquiátrica: Análise De Perfil Profissional E Educacional

“…Reforçando a importância da formação na área para atuação nos serviços de urgências e emergências psiquiátricas, este estudo encontrou associação estatística significativa entre a prática clínica e possuir pós-graduação em psiquiatria, ou seja, ter realizado essa especialização foi um preditor da prática clínica em urgências e emergências psiquiátricas. Consistente com esse resultado, estudo prévio (25) realizado em um serviço de urgência e emergência mostrou que a qualidade dos diagnósticos de enfermeiros psiquiátricos foi apropriada em 92% dos casos, quando comparados àqueles sem formação na área, observando-se também maior pertinência dos encaminhamentos realizados por esses especialistas, refletindo na melhora da satisfação do paciente com o atendimento de enfermagem. Nesse sentido, esse estudo reforça a importância da formação especializada em saúde mental e psiquiatria do profissional enfermeiro em serviços de urgência e emergência desta área.…”

Emergency department crowding: towards an agenda for evidence-based intervention: Figure 1

“…Constraints are also found in discharging patients safely into the community. Lack of community and psychiatric care and poor access to transport hamper discharge and contribute to ED crowding 28 33 47 52…”

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

“…The benefits associated with mental health nurse service provision in the ED have been recognised from numerous evaluations conducted internationally (Callahan et al, 2001;Clarke et al, 2005;Eales et al, 2006;Morgan and Coleman, 2000;Sinclair et al, 2006;Wand and Happell, 2001). However, there is significant variation in the way such services are designed and operate within the ED, such as team structure and where that sits within the ED, reporting mechanisms, patient referral and follow up.…”