What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open‐ended questionnaire study

Wright, Nicola; Panagioti, Maria; Grundy, Andrew; Waring, Justin

doi:10.1111/hex.13190

Cited by 12 publications

(30 citation statements)

References 33 publications

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“…Despite this, most of the safety concerns identified in this study appear to be valid throughout the pandemic. 2 For example, a recent study highlighted that the consequences of reduced clinical contact on self-harm are still unknown. 26 Moreover, our recent consultations with patient and public involvement members have showed that concerns around rapid discharges, accessing follow-up/community care, accessing in-patient services and use of technology were still current and valid problems from the perspective of patients and carers, 12 months after the pandemic began.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The transition of care is widely regarded as a vulnerable 'pinchpoint' in the patient journey. 1 Mental healthcare transitions in particular pose a major threat to patient safety [2][3][4] with ineffective discharge from acute mental health services associated with the increased likelihood of adverse outcomes, such as suicide and selfharm. 4,5 Even where there is good integration, the pressure on all services can still make transitions problematic, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England

et al. 2021

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Background The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. Aims This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and policy of mental health transitions as a result of coronavirus disease 2019 (COVID-19) on perceived healthcare quality and safety. Method Thirty-four participants were interviewed about quality and safety in mental health transitions during May and June 2020 (the end of the first UK national lockdown). Semi-structured remote interviews were conducted to generate in-depth information pertaining to various stakeholders (patients, carers, healthcare professionals and key informants). Results were analysed thematically. Results The qualitative data highlighted six overarching themes in relation to practice changes: (a) technology-enabled communication; (b) discharge planning and readiness; (c) community support and follow-up; (d) admissions; (e) adapting to new policy and guidelines; (f) health worker safety and well-being. The COVID-19 pandemic exacerbated some quality and safety concerns such as tensions between teams, reduced support in the community and increased threshold for admissions. Also, several improvement interventions previously recommended in the literature, were implemented locally. Discussion The practice of mental health transitions has transformed during the COVID-19 pandemic, affecting quality and safety. National policies concerning mental health transitions should concentrate on converting the mostly local and temporary positive changes into sustainable service quality improvements and applying systematic corrective policies to prevent exacerbations of previous quality and safety concerns.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England

et al. 2021

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“…Such communication and co-ordination failures lead to traumatic experiences for patients, and several adverse outcomes including patient safety incidents at pre-and post-discharge (2,3). Early and appropriate discharge planning could make inpatient care safer and more person-centered, reduce unnecessary delays in hospital stays and contribute to a smoother adjustment of patients to the community after discharge (1,(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…SAFER is designed as a generic discharge planning intervention without targeting any specific setting/condition and therefore might fail to fully address the unique discharge planning challenges in mental health settings. Interviews with stakeholders (e.g., professionals, service users, families, and key informants) highlighted that SAFER needs to be significantly modified to in terms of content, timelines and staff roles for mental health settings ( 4 , 13 ). Stakeholder also agreed some components could be excluded if not directly applicable or supplemented by additional useful components ( 4 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…Interviews with stakeholders (e.g., professionals, service users, families, and key informants) highlighted that SAFER needs to be significantly modified to in terms of content, timelines and staff roles for mental health settings ( 4 , 13 ). Stakeholder also agreed some components could be excluded if not directly applicable or supplemented by additional useful components ( 4 , 13 ). Improving inter-agency and multi-professional communication, information sharing and patient empowerment/shared decision making are key to improving safety in mental health care transitions ( 4 , 9 , 14 , 15 ); however, these are not current components of the original SAFER patient flow bundle ( 4 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method

et al. 2021

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Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer.Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community.Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7–9) using an online questionnaire then remote online face-to-face meetings.Results: Five of the six “SAFER” patient flow bundle components were appropriate and feasible for inpatient mental health. One component, “Early Flow,” was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement.Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.

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Conceptual and practical challenges associated with understanding patient safety within community‐based mental health services

Averill

Vincent

Reen

et al. 2022

Health Expectations

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Patient safety problems stemming from healthcare delivery constitute a global public health concern and represent a pervasive barrier to improving care quality and clinical outcomes.However, evidence generation into safety in mental healthcare, particularly regarding community-based mental health services, has long fallen behind that of physical healthcare, forming the focus of fewer research publications, and developed largely in isolation from the wider improvement science discipline. We argue that this disconnect yields, and is likely the product of, both conceptual and practical difficulties which must be overcome to advance the science and improvement of safety in mental health services. Drawing upon theoretical and empirical evidence from the fields of mental healthcare, patient safety, and improvement science, challenges encountered in our efforts to understand patient safety problems in community-based mental health services, a particularly unmapped area of safety, are described. We consider the origins of these issues and their probable implications for patient safety science and clinical care. Challenges in defining safety in the context of community mental healthcare, establishing what constitutes a 'preventable' safety problem, and the available evidence, are outlined. The dominant risk management approach to safety in mental healthcare, which positions service users as the origin of risk, has seemingly prevented a focus on proactive safety promotion, considering iatrogenic harm and latent system hazards. We propose a wider conceptualisation of safety and discuss important next steps for the integration and mobilisation of disparate sources of 'safety intelligence', to advance how safety is conceived and addressed within community mental healthcare.

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What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open‐ended questionnaire study

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 33 publications

Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England

Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England

Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method

Conceptual and practical challenges associated with understanding patient safety within community‐based mental health services

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