Developing a model of best practice for teams managing crisis in people with dementia: A consensus approach

Abstract

Background: Teams delivering crisis resolution services for people with dementia and their carers provide short-term interventions to prevent admission to acute care settings. There is great variation in these services across the UK. This article reports on a consensus process undertaken to devise a Best Practice Model and evaluation Tool for use with teams managing crisis in dementia. Methods: The Best Practice Model and Tool were developed over a three stage process: (i) Evidence gathering and generation of candidate standards (systematic review and scoping survey, interviews and focus groups); (ii) Prioritisation and selection of standards (consultation groups, a consensus conference and modified Delphi process); (iii) Refining and operationalising standards (consultation group and field-testing). Results: 165 candidate standards arose from the evidence gathering stage; were refined and reduced to 90 through a consultation group exercise; and then reduced to 50 during the consensus conference and weighted using a modified Delphi process. Standards were then operationalised through a clinical consultation group and field-tested with 11 crisis teams and 5 non-crisis teams. Scores ranged from 48-92/100. The median score for the crisis teams was 74.5 (range 67-92), and the median score for non-crisis teams was 60 (range 48-72).Conclusions: With further psychometric testing, this Best Practice Model and Tool will be ideal for the planning, improvement and national benchmarking of teams managing dementia crises in the future.

How to measure staff continuity in intensive psychiatric home treatment: a routine data and single case analysis

“…This should be regularly monitored at least on a random basis in IOC teams and upper limits should be defined for the number of staff involved in a treatment episode. These should be specifically included in existing best practice models and fidelity scales for IOC, which already call for the introduction of a key worker system to improve treatment continuity, but without further specification (14,35).…”

“…Research on IOC shows mainly positive effects, such as a decrease in symptom severity, inpatient treatment days, and discontinuation of treatment (4)(5)(6), while costs remain the same or decrease compared to inpatient admission (4,7). One of the key issues of intensive IOC, on the other hand, is the lack of staff continuity during single care episodes (8)(9)(10)(11)(12)(13)(14)(15). While in the inpatient setting, usually several members of a multiprofessional team are simultaneously present on the ward for several days in a row, contacts in IOC are often provided by practitioners who change on a daily basis.…”

“…A continuous relationship between user and practitioner is described as a key principle of psychiatric care (14,17). In a widespread definition, this element of continuity of care (CoC) is named relational continuity and described as "the therapeutic relationship between a patient and one or more clinicians […] and provides coherence through clinicians' growing comprehensive knowledge of the patient" (18).…”

“…On the one hand, studies on crisis resolution teams (CRT), a concrete model of IOC, conclude that staff continuity is crucial to service delivery (9,10,14,28,29). On the other hand, service users report to have seen too many staff involved in each episode of care, with contacts often being fleeting, superficial and requiring them to repeat their story several times (3, 8, 10, 29-32).…”

“…A recent survey of patient satisfaction among users of psychiatric Home-Treatment (HT) identified poor staff continuity as one of the key sources of dissatisfaction (33). Although best practice guidelines and a fidelity scale for CRTs demand a named key worker, about which service users should be informed (14,34), a recent implementation study carried out in 75 CRTs in the UK shows an average of poor fidelity to the model for staff CoC, indicating a need for improvement (35).…”