A Formative Quality Improvement Implementation Study To Improve Care Transitions Through Information Capture Upon Admission To An Acute Mental Health Ward

Abstract

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.