The development of pathways for responding to patient complexity in a liaison psychiatry setting

Abstract

<jats:sec><jats:title>Objectives:</jats:title><jats:p> The aims were to develop and operationalise a method of identifying patients at increased risk of adverse outcomes due to clinical and systems complexity within consultation-liaison psychiatry (CLP), and to formalise escalation processes for enhanced input with targeted clinical and organisational support. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> The literature pertaining to methods for identifying and responding to complexity in general hospital settings was reviewed. An Escalation Tool operationalising the identification of complexity and response pathways was devised and tested. Feedback on the face validity and utility guided refinement. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Two established tools that assess complexity, INTERMED and the Patient-Centred Accreditation method (PCAM) and a novel ‘episode complexity’ screening method, were identified and informed the development of a tool for identifying and responding to complexity, which was then piloted. The tool was deemed useful, notwithstanding variability in scoring. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The Escalation Tool combined elements of existing measures to identify complexity in general hospital inpatients and guide pathways for action. It was well received and considered feasible for implementation, with local adaptation according to available resources. </jats:p></jats:sec>

Beyond Diagnosis and Comorbidities—A Scoping Review of the Best Tools to Measure Complexity for Populations with Mental Illness

“…The geographic context in which each of these tools was developed was also wide-ranging. For examples, VCAT [ 30 ], HexCom [ 39 ], Escalation tool [ 40 ], and OCCAM [ 35 ] were developed for specific geographic regions in Vancouver (Canada), Catalonia (Spain), Sydney (Australia), and Oxford (England), respectively, while other tools were developed for national (e.g., PCAT [ 41 ]—United Kingdom) or multinational use (e.g., COMPRI [ 34 ]—Spain, Italy, Hungary, Netherlands, Portugal, Germany, Denmark). Importantly, these tools were also developed for a myriad of healthcare settings and uses.…”

“…Six of the fourteen tools met the specific focus of this review as they were field-tested or validated in a mental health setting—AMPS [ 36 ], CPM [ 42 ], INTERMED [ 44 ], VCAT [ 30 ], Escalation tool [ 40 ], and Complexity checklist [ 43 ]—of which four were directly developed for and tested in a mental health setting (AMPS, INTERMED, VCAT, and Escalation Tool) and two (Complexity checklist and CPM) had strong representation or identified individuals with mental illness and psychiatric diagnoses in a general healthcare setting. Each of the six tools has unique attributes that define them, and these attributes help to guide end-users in their decision on which tool(s) to use based on their unique needs.…”

“…Of the six complexity tools for patients with mental illness identified—the AMPS [ 36 ], CPM [ 42 ], INTERMED [ 44 ], VCAT [ 30 ], Escalation tool [ 40 ], and Complexity checklist [ 43 ]—the current review summarized and compared highly specific details on the characteristics and indicators of each tool to assist with decision-making processes when selecting a tool, depending on one’s needs, population, and resources available. The review found that, while each of the six tools included a psychological domain, only four (i.e., the AMPS, INTERMED, VCAT, and Escalation Tool) also included a psychosocial domain.…”