A multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP)

Trigwell, Peter; Kustow, James

doi:10.1192/pb.bp.115.051458

Cited by 17 publications

(27 citation statements)

References 3 publications

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“…Many patients are only seen for a single assessment and patients present with a wide range of differing mental and physical health problems. The Royal College of Psychiatrists has published a Framework for Recording Outcomes and Measurement in Liaison Psychiatry [ 41 ], which should improve consistency in data collection, but the framework has not been universally adopted by services. A bespoke liaison symptomatic outcome measure has also been developed recently [ 42 ] but is not in widespread use.…”

Section: Resultsmentioning

confidence: 99%

A programme theory for liaison mental health services in England

House

Guthrie

Walker

et al. 2018

BMC Health Serv Res

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BackgroundMechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice.MethodWe synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems.ResultsWe identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred.ConclusionsOur findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.

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Section: Resultsmentioning

confidence: 99%

A programme theory for liaison mental health services in England

House

Guthrie

Walker

et al. 2018

BMC Health Serv Res

Self Cite

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“…In relation to outcomes, the Royal College of Psychiatrists, Liaison Faculty has recently developed a framework (FROM-LP) for the clinical evaluation of LP services [23]. This includes recommendations to use a simple set of measures to assess outcome, and a typology to describe different forms of clinical interventions employed by LP services; the-Identify and Rate the Aim of the Contact (IRAC) scale [23]. IRAC has shown good clinical utility in correctly identifying the type of interventions implemented by LP teams [24].…”

Section: Introductionmentioning

confidence: 99%

The nature and activity of liaison mental services in acute hospital settings: a multi-site cross sectional study

Saraiva

Guthrie

Walker

et al. 2020

BMC Health Serv Res

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Background: To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. Methods: Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures. Results: A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common clinical problems were co-morbid physical and psychiatric symptoms, self-harm and cognitive impairment. The main types of intervention delivered were diagnosis/formulation, risk management and advice. There were differences in the type of clinical problems seen by the services between EDs and wards, and also differences between the work conducted by doctors and nurses. Almost half of the contacts were for continuing care, rather than assessment. Eight per cent of all referrals were offered follow up with the LP team, and approximately 37% were referred to community or other services. Conclusions: The activity of LP services is related to the flow of patients through an acute hospital. In addition to initial assessments, services provide a wide range of differing interventions, with nurses and doctors carrying out distinctly different roles within the team. The results show the volume and diversity of LP work. While much clinical contact is acute and confined to the inpatient episode, the LP service is not defined solely by an assessment and discharge function; cases are often complex and nearly half were referred for follow up including liaison team follow up.

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“… 16 There is also an increasing expectation that outcome measures are available to secure funding and support liaison psychiatry service growth. In response to this, we have been collecting outcome measures as suggested by FROM-LP, 17 as well as HoNOS 65+, since January 2016. However, from the outcome data collected so far, we have some concerns about the validity of the measures and also that they do not measure the aspects of LPOA services that have previously been shown to make them cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Liaison psychiatry for older adults in the general hospital: service activity, development and outcomes

et al. 2018

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Aims and methodThis study used data collected to describe the activity, case-load characteristics and outcome measures for all patients seen during a 6-year period.ResultsThe service reviewed 2153 patients over 6 years with referral rates and case-load characteristics comparable to those described in a previous study period. The team saw 82% of patients on the day they were referred. Data and outcome measures collected showed significant complexity in the cases seen and statistically significant improvement in Health of the Nation Outcome Scales (HoNOS) scores following service input.Clinical implicationsThe outcome measures used were limited, but the study supports the need for specialist liaison psychiatry for older adults (LPOA) services in the general hospital. The Framework of Outcome Measures – Liaison Psychiatry has now been introduced, but it remains unclear how valid this is in LPOA. It is of note that cost-effectiveness secondary to service input and training activities are not adequately monitored.Declaration of interestNone.

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A multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP)

Cited by 17 publications

References 3 publications

A programme theory for liaison mental health services in England

A programme theory for liaison mental health services in England

The nature and activity of liaison mental services in acute hospital settings: a multi-site cross sectional study

Liaison psychiatry for older adults in the general hospital: service activity, development and outcomes

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