Background User involvement and recovery are now widely used terms within the mental health policy, research and practice discourse. However, there is a question mark about the impact these ideas have in everyday practice. Of interest is the degree of involvement in key transitions of care. In particular, admission to and discharge from acute inpatient mental health wards.

Background: Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.Methods: Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a fourstage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.Results: Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency 'Discharge Team' (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.Conclusion: This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and Frontiers in Psychiatry | www.frontiersin.org

Background Many interventions aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. We aimed to develop a novel information capture tool during admission that facilitates and accelerates discharge. Methods A quality improvement study to develop, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. We developed the tool by synthesising existing evidence and working with multi-agency and multi-disciplinary professionals in two co-design workshops. During implementation the tool was piloted on three wards. Ethnographic observations (145 h) and interviews (45) were used to evaluate the implementation of the tool across the three wards. Thematic synthesis was used to consolidate the findings. Results The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to hospital to facilitate discharge planning to community settings. Reported advantages of the tool were: (1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward (2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and (3) collecting information from the services/agencies to which patients will eventually be discharged. Conclusions Improving the quality of information at admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems. However, the introduction of the tool exacerbated complex, fragile distributed team dynamics, highlighting the importance of sociocultural context in information flow transitional interventions within distributed teams.

Background: Many interventions have been developed that aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. This quality improvement aims to develop a novel intervention that improves mental health care transitions by providing a framework for capturing relevant information at admission that facilitates and accelerates discharge. Methods: A formative implementation study to co-design, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. Two cycles of PDSA were completed which included two workshops based on the principles of co-design. During implementation the tool was piloted on three wards. Ethnographic observations (145 hours) and interviews (45) were used to evaluate the implementation of the tool across the three wards. The consolidated framework for implementation research was used to analyse and categorise the qualitative data generated. Results: The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to facilitate discharge planning. The most reported advantages of the tool were: 1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward 2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and 3) collecting information from the services/agencies that patients will eventually be discharged to. The consolidated framework analysis highlighted multiple barriers to implementation from both an outer and inner setting perspective. Conclusions: The results suggest that improving the quality of information captured upon admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems.

Background: Many interventions have been developed that aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. This quality improvement aims to develop a novel intervention that improves mental health care transitions by providing a framework for capturing relevant information at admission that facilitates and accelerates discharge. Methods: A formative implementation study to co-design, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. Two cycles of PDSA were completed which included two workshops based on the principles of co-design. During implementation the tool was piloted on three wards. Ethnographic observations (145 hours) and interviews (45) were used to evaluate the implementation of the tool across the three wards. The consolidated framework for implementation research was used to analyse and categorise the qualitative data generated. Results: The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to facilitate discharge planning. The most reported advantages of the tool were: 1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward 2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and 3) collecting information from the services/agencies that patients will eventually be discharged to. The consolidated framework analysis highlighted multiple barriers to implementation from both an outer and inner setting perspective. Conclusions: The results suggest that improving the quality of information captured upon admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems.