Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO): a protocol

Smith, Chris; Hewison, Jenny; West, Robert; Guthrie, Elspeth; Trigwell, Peter; Crawford, Mike; Murray, Carolyn J.; Fossey, Matt; Hulme, Claire; Tubeuf, Sandy; House, Allan

doi:10.1136/bmjopen-2019-032179

Cited by 7 publications

(16 citation statements)

References 25 publications

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“…Where hospitals have data and information systems in place it allows for a more granular examination of the work of the CLP service ( 27 , 28 ). Universal information systems would allow comparisons to be made to similar work conducted internationally, and to establish whether the work of Irish CLP differs from other countries, and where it needs to be improved ( 25 , 29 , 30 ). The data available suggests very high levels of clinical activity, compared to other areas of mental health services.…”

Section: Discussionmentioning

confidence: 99%

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

et al. 2021

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Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

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Section: Discussionmentioning

confidence: 99%

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

et al. 2021

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“…In this chapter, we describe the proposed methodology for work package 2a (ResearchOne-HES) and summarise the progression of the approval processes. We conclude that the methodology that we proposed to link HES and ResearchOne is feasible, based on successful enactment in another project at the University of Leeds (LP-MAESTRO 91,92 ). However, the time implications have been shown to be prohibitive within the context of a funded research project.…”

Section: What This Study Addsmentioning

confidence: 93%

“…No persistent link exists between HES and ResearchOne and, to our knowledge, no linkage methodology had been previously enacted between the two sources. Prior to the design of work package 2a (ResearchOne-HES), another research project at the University of Leeds (LP-MAESTRO 91,92 ) had proposed a methodology for linkage of data items between these two sources. LP-MAESTRO 91,92 was progressing through approval processes on the basis of this methodology and establishing precedent.…”

Section: Linkagementioning

confidence: 99%

“…Prior to the design of work package 2a (ResearchOne-HES), another research project at the University of Leeds (LP-MAESTRO 91,92 ) had proposed a methodology for linkage of data items between these two sources. LP-MAESTRO 91,92 was progressing through approval processes on the basis of this methodology and establishing precedent. Therefore, the same linkage methodology (Figure 6) was adopted in the design of work package 2a (ResearchOne-HES).…”

Section: Linkagementioning

confidence: 99%

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Safety of disinvestment in mid- to late-term follow-up post primary hip and knee replacement: the UK SAFE evidence synthesis and recommendations

Kingsbury

Smith

Czoski-Murray

et al. 2022

Health Soc Care Deliv Res

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Background Joint replacement surgery has revolutionised the management of degenerative joint disease. Increasing demand for surgery and post-surgical reviews has overwhelmed orthopaedic services and, consequently, many centres have reduced or stopped follow-up. Such disinvestment is without an evidence base and raises questions regarding the consequences to patients. Objectives To produce evidence- and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Our research question was ‘Is it safe to disinvest in mid- to late-term follow-up of hip and knee replacement?’. Methods The study comprised three complementary evidence synthesis work packages to inform a final consensus process. Work package 1 was a systematic review of the clinical effectiveness and cost-effectiveness literature. Work package 2 used routine national data sets (i.e. the Clinical Practice Research Datalink–Hospital Episode Statistics, Hospital Episode Statistics–National Joint Registry–patient-reported outcome measures) to identify pre, peri and postoperative predictors of mid- to late-term revision, and prospective data from 560 patients to understand how patients present for revision surgery. Work package 3 used a Markov model to simulate the survival, health-related quality of life and NHS costs of patients following hip or knee replacement surgery. Finally, evidence from work packages 1–3 informed a face-to-face consensus panel, which involved 32 stakeholders. Results Our overarching statements are as follows: (1) these recommendations apply to post primary hip and knee replacement follow-up; (2) the 10-year time point in these recommendations is based on a lack of robust evidence beyond 10 years; and (3) in these recommendations, the term ‘complex cases’ refers to individual patient and surgical factors that may increase the risk of replacement failure. Our recommendations are as follows: for Orthopaedic Data Evaluation Panel 10A* (ODEP-10A*) minimum implants, it is safe to disinvest in routine follow-up from 1 to 10 years post non-complex hip and knee replacement provided that there is rapid access to orthopaedic review; (2) for ODEP-10A* minimum implants in complex cases or non-ODEP-10A* minimum implants, periodic follow-up post hip and knee replacement may be required from 1 to 10 years; (3) at 10 years post hip and knee replacement, clinical and radiographic evaluation is recommended; and (4) after 10 years post hip and knee replacement, frequency of further follow-up should be based on the 10-year assessment (note that ongoing rapid access to orthopaedic review is still required) [Stone M, Smith L, Kingsbury S, Czoski-Murray C, Judge A, Pinedo-Villanueva R, et al. Evidence-based follow-up recommendations following primary hip and knee arthroplasty (UK SAFE). Orthop Proc 2020;102–B:13. https://doi.org/10.1302/1358-992X.2020.5.013]. Limitations The current absence of data beyond 10 years restricted the evidence base. Conclusions For ODEP-10A* prostheses, the UK SAFE programme demonstrated that it is safe to disinvest in routine follow-up in the 1- to 10-year period after non-complex hip and knee replacement. At 10 years, clinical and radiographic review is recommended. Complex cases, implants not meeting the 10A* criteria and follow-up after revision surgery are not covered by this recommendation. Future work The evidence base for follow-up after 10 years requires further evaluation. Further work should establish the most clinically effective and cost-effective model of delivering a rapid access service and evaluate alternative models for follow-up services, such as virtual clinics. Finally, the needs and outcomes of patients who are symptomatic but do not have appropriate follow-up should be investigated. Study registration This study is registered as PROSPERO CRD42017053017. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 16. See the NIHR Journals Library website for further project information.

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“…Today, we know that the results of LPT interventions are heterogeneous, with the formation and composition of the teams also varying ( Saraiva et al, 2020 ; Walker et al, 2018 ). Hence the importance of standardizing and protocolizing its activity, including the coordination of outpatient care in Mental Health programs ( Smith et al, 2019 ; Wood & Wand, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Liaison psychiatry before and after the COVID-19 pandemic

E¹,

Alonso-Sanchez²,

Ayuso-Mateos³

et al. 2022

Psychiatry Research

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Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO): a protocol

Cited by 7 publications

References 25 publications

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

Safety of disinvestment in mid- to late-term follow-up post primary hip and knee replacement: the UK SAFE evidence synthesis and recommendations

Liaison psychiatry before and after the COVID-19 pandemic

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