Efficacy of a dementia intensive support (DIS) service at preventing admissions to medical and psychiatric wards: qualitative and quantitative evaluation

Abstract

Aims and method To establish whether a dementia intensive support (DIS) service that is part of a crisis resolution and home treatment team for older people is preventing admissions to acute hospital and psychiatric wards. The number of referrals in 2017 to the DIS service was established and those admitted to hospital ascertained. Senior doctors examined 30 sets of notes in detail and reached a conclusion on whether DIS had contributed to admission prevention. This information was then re-examined in two meetings with at least eight senior psychiatrists present. A consensus opinion was then reached as to whether DIS had contributed to admission prevention in each case. Results Over 12 months, 30/171 patients (18%) referred were admitted to hospital. For the subset of 30 referrals examined in detail, DIS contributed to admission avoidance in 21 cases (70%). Clinical implications Our evaluation demonstrates that the DIS service is an effective way of preventing admission.

Chatting: Family Carers’ Perspectives on Receiving Support from Dementia Crisis Teams

“…To the extent that crisis teams fulfill the policy goal of enabling more people to live for longer in their own homes, carrying this out simultaneously assigns greater numbers of caregivers to a precarious equilibrium made vulnerable and stressful by having to constantly respond to a person’s changing and sometimes challenging needs and behaviors. Seeing how caregivers attach such great significance to ‘just’ chatting with a healthcare practitioner indicates how socially isolated [ 18 ] and emotionally vulnerable their situation becomes within the care system [ 19 ]. This helps explain why Mrs Brown rejects what she characterizes as the crisis team’s attitude that ‘everything is fine now, off we go’ when the social contact she found so valuable was simply removed and not sustained.…”

“…This helps explain why Mrs Brown rejects what she characterizes as the crisis team’s attitude that ‘everything is fine now, off we go’ when the social contact she found so valuable was simply removed and not sustained. Recognizing the actions that crisis teams take to reduce inpatient admissions makes apparent that crisis services often do not consider caregivers’ or patients’ relational needs [ 19 ], suggesting clear implications for future practice and research.…”

The evidence for introducing case-finding for delirium and dementia in older medical inpatients in a New Zealand hospital

“…Enhanced case-finding should be linked with high quality care packages whilst in hospital, 12 but patients also require comprehensive follow-up to monitor recovery, identify persistent cognitive impairment and plan future care, 13 and integration with appropriate dementia services such as crisis services designed to prevent unnecessary admissions to hospital. 14 A model that combines intensive crisis services for dementia with high quality inpatient care for delirium and dementia, and assertive outpatient follow-up to support recovery, is worthy of consideration in our local hospital setting, although such services have yet to be tested in New Zealand.…”

Predicting patients with dementia most at risk of needing psychiatric in-patient or enhanced community care using routinely collected clinical data: retrospective multi-site cohort study

“…Some patients need further and more intensive psychiatric support, including intensive care in the community through psychiatric ‘crisis teams’ or admission to specialist dementia wards in psychiatric hospitals, although the proportion needing these services is not known. 2,3 Clinical criteria for entry to crisis team care vary, but in Cambridgeshire and Peterborough (UK) patients are considered appropriate if their clinical condition is such that without intensive support they would be at significant risk of harm or require admission. Patients are considered for in-patient care if it is not possible to provide appropriate or safe care in the community.…”