Emergency department care for patients with mental health problems, a longitudinal registry study and a before and after intervention study

Linden, Margareta; Balk, Ferdi J.E.; Hoeven, Bastiaan J.H. Van Der; Loon, Merel van; Voeght, Frans J. De; Linden, Naomi van der

doi:10.1016/j.ienj.2019.02.003

Cited by 8 publications

(23 citation statements)

References 13 publications

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Section: Introductionmentioning

confidence: 99%

“…Presentation rates to ED for people with mental health, drug health and behavioural problems continue to increase in Australia and globally, placing considerable strain on hospital and community mental health services. [1][2][3][4][5] Responding to a patient in an acute state of agitation or distress requires considerable ED resources 6 and is associated with increased length of stay and greater risk of adverse events. 2 In response to this growing clinical challenge and concerns over waiting times a nurse practitioner (NP)-led extended hours mental health liaison nurse (MHLN) team was established in a metropolitan tertiary hospital ED in Sydney, New South Wales (NSW) in 2012 and subsequently evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating an emergency department‐based mental health liaison nurse service: A multi‐site translational research project

Wand

Collett

Cutten

et al. 2020

Emerg Medicine Australasia

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Objective We aimed to translate and evaluate a model of mental health liaison nursing (MHLN) care that was embedded within EDs. Methods The 12 month mixed‐methods translational research study incorporated descriptive data on ED presentations, waiting times for MHLN intervention, time spent in ED and discharge arrangements across three EDs in New South Wales. The study involved an inner‐city ED (where the model was first established) and two rural sites. Surveys were conducted on a subset of ED patients (n = 58), and emergency and psychiatry staff (n = 52). Results Triage category 3 presentations accounted for 49% of the MHLN team workload. Response times and ED length of stay varied between city and rural sites, with rural sites demonstrating prompt response times and reduced ED length of stay. The model was strongly endorsed by patients and staff, with 95% of staff and 85% of patients across the three sites recommending the model be implemented in other emergency settings. The need for adequate resources to maintain designated levels of staffing and sustain this model of care was highlighted. Conclusion Findings from the present study indicate that a model of ED‐based MHLN care developed in a metropolitan setting was successfully translated to two rural sites. However, the model needs to adhere to certain key principles, and be adequately resourced in order to be sustainable and improve outcomes for ED patients and access to community care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating an emergency department‐based mental health liaison nurse service: A multi‐site translational research project

Wand

Collett

Cutten

et al. 2020

Emerg Medicine Australasia

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“…Presentation rates to Emergency Departments (ED) for people with mental health, drug health mental distress and behavioural problems continue to increase in Australia and globally, placing considerable strain on hospitals and mental health services (Australasian College for Emergency Medicine, ACEM 2018; Australian Institute of Health & Welfare 2018; Bureau of Health Information 2019; Fleury et al 2019; Perera et al 2018; Van Der Linden et al 2019). Moreover, individuals with mental health and behavioural concerns disproportionately experience unacceptably long waits in the ED (Australasian College for Emergency Medicine 2018), an environment that can exacerbate mental distress due to noise, busyness, lack of privacy, and bright lights (Carstensen et al 2017; Harris et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Patient and clinician experiences with an emergency department‐based mental health liaison nurse service in a metropolitan setting

Wand

Collett

Cutten

et al. 2020

Int J Mental Health Nurs

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As part of a larger multi‐site translational research project this study explored patient and staff experiences, perspectives, and recommendations in relation to a mental health liaison nursing (MHLN) team established in the emergency department (ED) of a metropolitan hospital in New South Wales, Australia. Semi‐structured interviews were conducted with a sample of ED patients (n = 26), ED nurses (n = 10), ED consultants (n = 9), and members of the consultation–liaison psychiatry team (n = 5). Data were analysed thematically. Patients emphasized the numerous therapeutic qualities of the MHLN role, the promptness with which they were seen and the value of follow‐up. Privacy was identified as important, and some negative experiences were reported. Staff identified that the MHLN team are able to respond to a variety of ED presentations in a timely manner. There was recognition that the MHLN team needs to be integrated within the ED as a specialist resource that builds ED capacity. Consistent staffing of the MHLN team with designated clinicians was also considered essential. Integrating a nurse practitioner‐led MHLN team within the ED has demonstrated multiple benefits for patients, ED staff, and overall service provision. Incorporating a specialist mental health nursing service within the ED builds confidence in ED clinicians. Members of the psychiatry team also acknowledge the value of aligning the clinical governance of the MHLN team within the ED and the reduced workload this model of care has on their service provision to ED, freeing them up to concentrate on their broader general hospital role.

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“…Overall, endeavours to advocate for better access to care for those experiencing mental health issues, often influenced by drug and social factors (Yap et al 2020), remain a key focus for the local ED. Whilst ownership, in accepting and providing mental health care within this acute setting when there is 'nowhere else to go (Duggan et al 2020, pg.1)', is important, so is ED's role in raising concerns and advocating for better service access, other than waiting in a busy ED (Allison et al 2019;Beale, 2022;Van Der Linden et al 2019;White & Brooker 2020).…”

Section: Challenging the Status Quo And Advocating For Better Patient...mentioning

confidence: 99%

“…2019; Van Der Linden et al . 2019). Both issues add extra challenges, with ED staff also reporting a lack of knowledge and confidence around the best way to assist and manage mental health presentations (Beks et al .…”

Section: Introductionmentioning

confidence: 99%

Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective

O’Sullivan

2022

Int J Mental Health Nurs

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Providing appropriate, timely intervention and care to people who present with mental health issues to an Emergency Department presents unique ongoing challenges, often affecting patient experiences and outcomes. To address such concerns, a Mental Health Liaison Nurse role, led by a Mental Health Nurse Practitioner, was introduced to a regional Emergency Department. This role provided integrated emergency‐based mental health clinical practice, with positive findings reported in a recently published multi‐site translational research project. With sound quantitative and qualitative evidence detailing the benefits of this role, the experiential perspective from a clinician working in this frontline space further confirms the importance of having access to such a position in leading cultural and systemic change. This discussion article identifies key processes that align current research with the clinical perspective. Such processes recognize the challenges of implementing a new role and moving forward from these to embed consistent clinical practices. The need to build sound internal and external stakeholder partnerships, effect change implementation, and assign recommendations to ensure sustainability of improved practice and processes are highlighted in this paper. This article is, therefore, designed to assist other advanced practice nurses, who may be embarking on a similar journey and want to influence organizational policy and practice.

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Emergency department care for patients with mental health problems, a longitudinal registry study and a before and after intervention study

Cited by 8 publications

References 13 publications

Evaluating an emergency department‐based mental health liaison nurse service: A multi‐site translational research project

Evaluating an emergency department‐based mental health liaison nurse service: A multi‐site translational research project

Patient and clinician experiences with an emergency department‐based mental health liaison nurse service in a metropolitan setting

Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective

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