Improving continuity of care across psychiatric and emergency services: combining patient data within a participatory action research framework

Abstract

Presented with the concerns of emergency department nurses about providing appropriate and co-ordinated care for patients seeking mental health services, a Monash University School of Nursing, Victoria, Australia, research team chose a participatory action research strategy. Jointly executed with staff from the Peninsula Health Care Network, the research process brought together in a number of fora multiple disciplines involved in the care and management of psychiatric patients. The participatory action research process itself was the first step in remedial action. Through it, participants and management gained a firmer view of the issues facing Frankston Hospital Emergency Department staff in dealing with psychiatric patients, and in securing their access to suitable pathways of care. Other research outcomes included: a compilation of summary statistics showing patterns of use by psychiatric patients of Frankston Hospital's Emergency Department; beginning discussions about pathways of care for these patients; and the development of a screening tool to be used by the triage nurse for at-risk psychiatric patients presenting to the Emergency Department.

Psychiatric Emergency Services: A Review of the Literature and a Proposed Research Agenda

“…Assessment of patients, who present to emergency departments with mental health complaints, is often delayed as psychiatric cases are classified as semi-urgent. As a result, a significant number of these patients leave the emergency department without receiving an evaluation, referral, or treatment (44). Several studies that examine factors affecting response time (45,46) have found that the psychiatric patients wait significantly longer than medical patients and that presentation during day or evening shift, with substance abuse diagnoses, by police/mobile team referral, or with a need for medication all increase wait time.…”

“…It appears that nonclinical (sociodemongraphic) factors influence treatment decisions (50,51). Research has examined the types of methods and tools that are used in crisis evaluation (44,(52)(53)(54)(55)(56). Several studies have examined reliability and addressed variations in evaluation across psychiatric clinicians (57)(58)(59)(60)(61).…”

Continuity of care for carers of people with severe mental illness: Results of a longitudinal study

“…Sytema and colleagues (1997), however, also focused on flexibility of care, operationalised as the combinations of in-, day-and out-patient care used during follow-up, while other studies have focused on cross-boundary continuity between primary and secondary care ), psychiatric and emergency services (Heslop et al 2000), or inpatient and community settings (Kopelowicz et al 1998). …”

Delivery suite assessment unit: auditing innovation in maternity triage

“…This can make the triage process more problematic, thus, interpretation services are essential (DeVore, 1999). Heslop et al (2000) discussed the enhanced expertise and decision making abilities of senior health professionals. These patterns of expert decision making reflect Benner's (2001) definition of the expert practitioner, who uses intuition to reach clinical decisions (Marsden, 2000).…”