The effect of a hospital liaison psychiatry service on inpatient lengths of stay: interrupted time series analysis using routinely collected NHS hospital episode statistics

Abstract

Background: The purpose of the study was to determine whether establishment of a specific liaison psychiatry service designed to offer a rapid response with facilitated hospital discharge led to reduced acute hospital length of inpatient stay. Methods: We used interrupted time series based upon routine NHS data from secondary care service in two acute general hospitals, for all adult (16+ years) inpatient admissions (114,029 inpatient spells representing 70,575 individual patients) over 3 years. Results: Length of stay reduced over time in both hospitals. Against a background of falling length of stay across the study period, there was no discernible effect of the rapid access/early discharge liaison service on length of stay, either as a step change or linear decline. This finding held for all patients and for those over 65 years and those discharged with a mental health diagnosis. Conclusions: Using routine NHS data for a whole hospital it was not possible to replicate a previous report that a rapid access liaison psychiatry service for inpatients produces substantial reductions in length of stay, and commissioners of services should be cautious of claims to the contrary. Further research to determine if there is an effect for subgroups will require major improvements in the way co-morbid mental disorders are coded in NHS practice.

The effect of a peer-led problem-support mentor intervention on self-harm and violence in prison: An interrupted time series analysis using routinely collected prison data

“…The costs of such evaluations are large, it would therefore be useful to know whether routinely collected prison data could be used to assess intervention change. Other evaluations of routinely collected data use interrupted time series designs and mainly predominate in healthcare settings, the strengths of the design include the use of existing longitudinal data [ 18 , 19 ].…”

Understanding liaison psychiatry commissioning: an observational study

“…There is also no way of accurately recording the type and number of patients that receive interventions, and what these interventions and outcomes are. This discrepancy between clinician and commissioner perspectives is supported by House et al (2020), who reports that: clinicians believe they collect outcomes routinely because they monitor how individual patients do, and consequently believe they save money because they see the evidence in cases where they change the trajectory of care; and commissioners are less convinced because they do not see the dramatic length of stay changes claimed for the UK rapid assessment interface and discharge (RAID) liaison psychiatry model (Tadros et al , 2013) but they do not see the convincing routine collection of outcomes for whole services. …”

“…There is also no way of accurately recording the type and number of patients that receive interventions, and what these interventions and outcomes are. This discrepancy between clinician and commissioner perspectives is supported by House et al (2020), who report that: a.) clinicians believe they collect outcomes routinely because they monitor how individual patients do, and consequently believe they save money because they see the evidence in cases where they change the trajectory of care and b.)…”

“…Challenges identified in this study centred around insufficient staff to deliver the service and to enable evaluation of outcome measures and cost effectiveness, similar to the findings of Parsonage et al (2014). Some of the more recent international studies in this area have focused on the positive impact of liaison psychiatry on reductions in length of stay (Vulser et al, 2019, Oldham et al, 2019, House et al, 2020, improvements in emergency department waiting times (Evans et al 2019) and overall cost savings benefits (Okoronkwo, 2019). However, there is little consistency in measurement and a wide variability in the quality of research design, with a number of authors calling for routine and systematic measurement (Trigwell et al, 2015, Fossey and Parsonage, 2014, Kroll et al, 2020…”

Quality assessment of a consultation-liaison psychiatry service

“…It also provides teaching and research activities on mental health comorbidity to medical staff of non-psychiatric departments of general hospitals [ 7 ]. Although CLP services in the general hospital does not seem to reduce the length of hospitalization [ 8 ], they have a positive impact on mental health problems [ 9 ], and are cost effective [ 10 ]. Joint projects between medical and psychiatric professionals seem to ensure the best way to reduce the existing gap between medical specialties and psychiatry [ 11 ]; Consultation-Liaison Psychiatry services perform generally well in this context, with an earlier study showing an overall positive attitude towards CLP services among general medical hospital staff [ 12 ].…”