Developing integrated acute services: integrating acute inpatient ward and home treatment'

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Developing integrated acute services integrating
acute inpatient ward and home treatment.

• Dr Jaap Hamelijnck
• Veno Sunghuttee
• Dr Kit Wa Chan
• With thanks to the eastern region Acute Care
  Collaborative

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Objectives

• To know more about an integrated acute service.
• Learn about how this service developed and was
  implemented.
• Explore ways of making change happen.
• Share experiences in the workshop group.

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Norfolk and Waveney Mental Health Partnership
Trust

• 4 acute services in the trust, City, County,
  Great Yarmouth and Waveney.
• Different stages of developing an integrated
  acute service.
• Single acute services forum
• Population of Waveney 130,000
• Population of GY 90,000

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Birth of Integrated teams

• The services started in 2003
• Gt Yarmouth unit opened July 2005
• Waveney unit opened October 2005
• Now operating as fully integrated teams,
  providing in-patient care and HT.
• Changes in the CMHTs

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Integrated Acute Service Providing

• Accept referrals
• Assessment
• Home Treatment
• Inpatient Care
• Community Crisis Bed
• Partial Hospitalisation
• Crisis Telephone Line

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How are we different?

• Integrated acute services - Extend the ward into
  the community
• Same team carry out inpatient, home-treatment and
  crisis resolution services.
• One assessment done at referral
• No barriers between these services.
• Provide 24 hours service, more responsive to
  crisis.
• Single acute services consultant lead medical
  team.

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Staffing Establishment

• 10 Senior Practitioners
• 11 Staff Nurses
• 3 Senior Support Workers
• 10 Support Workers
• 1 ASW
• 1 Senior OT
• 1 Technical Instructor
• 0.5 Art Therapist
• 0.5 Pharmacist
• 1 Team Leader
• 1 Acute Services Manager
• 1 Consultant
• 1 Specialist Registrar
• 1 SHO
• 1 Trust grade doctor
• 2 Administrators

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How does it work?

• 3 main shifts
• Early 07.00 14.30
• Late 13.20 21.20
• Night 21.00 07.20
• Also have long days 07.00-21.00
• Also have Twilights 16.00 00.00
• Medical staff 9.00 to 5.00
• On call medical staff 5.00 to 9.00

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Staffing Levels/Skill Mix

• Early and Late 6 staff per shift
• (3 registered and 3 support workers)
• Team Leader and ASW work 9.00-5.00
• 4 staff on Night Shift

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Admission Process

• Referral received and triaged by registered
  staff.
• Assessment allocated and Senior Practitioner
  leaves ward to carry out assessment.
• Action taken (inpatient or HT)
• Assessor completes all documentation including
  c/plan, r/assessment and SU admitted to their
  team. (Red, Blue, Green).

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On Admission

• Staff from red team responsible for reviewing
  documentation, discharge planning and daily
  11s.
• Review by medical staff
• Transfer to Home Treatment at earliest
  opportunity.
• Visited by Red Team staff at home and medical
  staff
• Discharged by original assessor from Acute
  Service.

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Progressive practice

• Art therapist
• Employment of service users
• ASW in team
• Crisis bed
• ECT HT
• Electronic patient notes
• Clozapine initiation

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Occupational Therapy

• Occupational therapist integrated in the acute
  services team.
• Works shifts.
• Practitioner in charge.
• normal OT role

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Art therapy

• Staff nurse money used to pay for it.
• Open group for all service users currently with
  acute service.
• Limited 1 to 1 sessions.
• Work with service users who go through an episode
  of acute mental illness.

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ECT Home Treatment Protocol

• All patients requiring ECT are admitted to the
  acute service.
• Acute care staff to arrange transport and act as
  escort (trained nursing staff).
• Patient to be prepared as per trust protocol.
• Following ECT the patient will be taken back to
  WAS and observed for 2-4 hr.
• Taken home, evening call and review next day.

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Protocol suitable for

• Patients not requiring hospitalisation.
• Family support (24hr observation).
• Medical fitness.
• Second part of ECT course.

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Differences the New service made

• Reduce the number of admission

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• Reduce the occupied bed days

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• Reduction of tribunal for patient under Mental
  Health Act

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Other benefits

• Reduced number of service interfaces faster
  response and less conflict
• Increased staff satisfaction
• Service users get to work with same staff
  throughout acute episode
• Wider range of care options available.
• Reduction in assessments

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