Balancing improvements to avoid out-of-area placements in acute psychiatric inpatient care

Abstract

BackgroundIncreasing pressures on acute adult NHS mental health services have led to the practice of sending patients out of their home county when there is insufficient local capacity to provide them with an acute psychiatric inpatient bed. AimsThis study sought to determine how rates of referrals, bed capacity and length of stay could be improved to avoid sending people out of their local area for care.MethodA discrete event simulation approach was applied to a mental health trust in the South West of England.ResultsThe model demonstrated that to achieve zero out-of-area placements the rate of referrals would have to be halved, bed capacity would have to be increased from 78 to 123 beds or length of stay would have to halve. If changes were made to all three elements of the system between 85 and 93 beds would be required in combination with between a 22% and 44% reduction in the rate of referrals and between a 11% and 21% reduction in length of stay.ConclusionsDue to non-linear effects in the system, avoiding the need to send patients out-of-area for care can best be achieved by improving multiple elements of the system in combination.