Splitting in-patient and out-patient responsibility does not improve patient care

Abstract

Over the past 15 years there has been a move away from consultants having responsibility for the care of patients both in the community and when in hospital towards a functional split in responsibility. In this article Tom Burns and Martin Baggaley debate the merits or otherwise of the split, identifying leadership, expertise and continuity of care as key issues; both recognise that this move is not evidence based.

In-patient treatment in functional and sectorised care: patient satisfaction and length of stay

“…The study findings provide evidence for the ongoing debate about the pros and cons of a functional split of psychiatrist responsibility between in-and out-patient care. 3 Despite the central importance of this question for patients and clinicians alike, decisions to change from one system to anotherin England mostly from a sectorised to a functional onehave been made in the absence of any high-quality evidence.…”

“…There is an ongoing debate about whether separate psychiatrists should be responsible for in-and out-patient care (functional care) or whether patients should be treated by the same psychiatrist across both settings (sectorised care). [1][2][3][4] Over the past decade, various mental health services in the National Health Service (NHS) in England have moved away from the traditional sectorised forms of care, with the majority of the 58 mental health trusts now operating a functional split. It has been argued that these changes towards functional care, which were often costly from both a financial and resource perspective, would improve in-patient care.…”

Laying new foundations for 21st century community mental health services: An Australian perspective

“…There is ongoing debate in the UK about whether the same psychiatrist should be responsible for a patient's care across inpatient and community settings (‘integrated model’ also known as the ‘sectorized’ model) or whether different psychiatrists should be responsible for care in different settings (‘functional split’ model; Burns & Baggaley ). While it is acknowledged that the concept of continuity of care is complex and multidimensional (Weaver et al .…”

“…While it is acknowledged that the concept of continuity of care is complex and multidimensional (Weaver et al . ), this paper limits the discussion to these two organizational arrangements which, it has been argued, impact on continuity of care (Burns & Baggaley ).…”

“…Opinion on this change is divided, with the main arguments in favour of the functional split between inpatient and community services being that it will lead to more efficiently run inpatient units with better ward leadership, throughput, patient safety, expertise, and job satisfaction (Burns & Baggaley ). On the other hand, proponents of the integrated model argue that it supports continuity of care and the therapeutic relationship, reduces the administrative and time burden of information transfer, and reduces the risks associated with transitions of care (Burns ; Burns & Baggaley ).…”