Readmissions
Workstream Overview
The Readmissions workstream is focused on reducing un-necessary readmissions to psychiatric inpatient units. It has identified the following issues as key to delivering a reduction in readmissions
01 Improve the delivery of and outcomes of assessments for admission
02 Improve the Inpatient Experience
03 Improve Discharge Planning
04 Ensure all services are focused on sustaining wellbeing and recovery
focusing on well being and recovery
what's happening
Readmissions
Local Delivery
The following are examples of work going on in Boards around these themes. We know there is much more happening out there - so if you have a piece of work you want featured, drop Rachna a line at
rachna.dheer@scotland.gsi.gov.uk
NHS Fife
Improving a Day Hospital Service
Starting in April 09, the Fife Programme Team and the South East Regional Team process mapped the admission, assessment and treatment pathway for the Weston Day Hospital in NE Fife. The event was carried out over 2 half days and included circa 30 staff and service users. After mapping the current pathway the team used an Experience Based Design ( EBD)approach to engage people that use the Weston Day Hospital to better understand not just their experience of the Hospital but also their needs at various stages in their journey along the pathway. This information was then fed into the second 'visioning' event. The outcome from the event was a redesigned pathway and a series of staffowned PDSA's aimed at reducing DNA's, increasing throughput and improving communication with referrers. Copies of the pathways, action plans and the EBD findings are available from
Beth Sparlingbeth.sparling@faht.scot.nhs.uk
NHS Highland
Use of SPARRAMD data
We asked frontline staff for feedback on the usefulness of having routine reports on the patients at highest risk of readmission (those at 50% risk and higher). Staff told us they are already aware of patients in the highest risk category, and had regular risk management procedures in place. As a direct result of this, we now send data banded by category of risk, 1-9%, 10-19% and so on.
In North Highland area, retrospective data on people admitted in the last quarter is compared with their number of admissions in the previous year. This makes the readmissions data more 'live', and therefore more applicable and meaningful.
The data is presented by CMHT area, CHP area, and is split into age bandings 16-64 and 65 and over. Access to this level of information supports frontline staff to identify patients who have the greatest need, and manage their resources accordingly.
As an additional quality measure, patients who are on the CPA (care programme approach), are cross referenced with those who have a CTO (compulsory treatment order), and listed by area. The table shows the number of patients in the community, and in hospital.
This has resulted in a draft policy to ensure people on a CTO are also on the CPA, which will ultimately result in better management of services and better outcomes for patients. For further information please contact
Morag Bramwell Data Analyst
morag.bramwell@nhs.net
Shirley Ritchie Care Programme Approach Facilitator
shirley.ritchie@nhs.net
Pat MacKenzie Senior Information Officer
pat.mackenzie@nhs.net
Cameron Stark Clinical Lead, MH Collaborative
cameron.stark@nhs.net
Lynda Forrest Programme Manager MH Collaborative
lynda.forrest@nhs.net
Releasing Time to Care, Mental Health
This is an exciting programme that supports mental health inpatient units to maximise the time spent in direct patient care. The Mental Health Collaborative has purchased the license for all adult acute beds in Scotland and will fund the extension of this license to cover older adult and Child and Adolescent Mental Health Services beds as requested, on a Board by Board basis.
This programme has already been implemented in a number of general hospitals across Scotland. The review of the generic pilots has been very positive in terms of measureable benefits such as improved staff morale and engagement, slicker processes within the ward and reduced waste. All these outcomes create an improved working environment for colleagues based on wards and enables them to spend more time on face-to-face contact with service users.
Roll out of this programme is optional and training for facilitators is currently provided nationally. NHS Borders, NHS Forth Valley, NHS Greater Glasgow and Clyde, NHS Lanarkshire, NHS Lothian and NHS Western Isles all have plans approved for roll out. If you would like further information on Releasing Time to Care, Mental Health then just contact your local Mental Health Collaborative Programme Manager or email
david.law@Scotland.gsi.gov.uk .
Crisis Network
The Crisis Network was the initiative of a small group of mental health professionals who thought it would be useful to bring together people involved in delivering crisis services to share ideas, challenges and good practice. It is a practitioner driven network - ie the topics and focus of events are decided by network members. The Mental Health Collaborative provides support by financing meetings as sharing good practice is one of our key aims. The next meeting is on 2nd September from midday onwards in Lanarkshire (venue to be confirmed). If you want to go on the network mailing list please send your name and email
rachna.dheer@scotland.gsi.gov.uk
CMHT Demand, Capacity, Activity and Queue Tool
A CMHT Demand, Capacity, Activity and Queue Tool is currently in final stages of testing. This allows CMHTs to model how many hours of time are needed to respond to their current numbers of referrals. Teams can then compare this with the actual hours of staff time they have for client contact and look at the difference. It then allows them to look at the impact of changes to practice - so they can see what the impact of reducing the DNA rate would be on their demand, the impact of increasing the number of people who are seen in groups rather than individually, the impact of reducing their sickness rates etc. Further information on this tool will be circulated to Boards shortly. To find out more please contact your Regional Information Manager
Contact details are at the end of the newsletter.
Scottish Recovery Indicator
The Scottish Recovery Indicator ( SRI) is a web based tool designed by the Scottish Recovery Network. The tool helps organisations to determine whether their mental health services are underpinned by an ethos of recovery. The application of the tool helps generate conversations within teams about recovery supporting environments and person centred approaches and enables focus on areas of service that need to be changed and improved.
Data is gathered by examining organisational processes relating to assessment, care planning, policies and procedures as well as through interviews with service users and service providers.
Organisations can use this information to rate their level of recovery orientation against a series of nineteen indicators. The results can be used to highlight areas for improvement.
A central aim of the Mental Health Collaborative is to help boards to establish a culture of continuous improvement.
The programme promotes the use of proven, improvement tools and techniques to decide what needs to improve, how to identify that change has produced an actual improvement and how to test changes. It focuses on involving those delivering and using the services in highlighting areas for improvement, coming up with ideas about how to improve and testing changes. These skills and methods can enable and support organisations to agree and test changes needed to achieve improvements to their overall ratings within the SRI. To find out more about the SRI please go to www.scottishrecoveryindicator.net
OTHER PROGRAMMES
There are a range of other national programmes focused on work that compliments that of the collaborative. There is not space here to update on every other programme - but we will highlight one or two each newsletter.