Improving the Care of Children and Young People (CYP) Admitted to Adult Mental Health Psychiatric Beds in NHS Tayside Using Quality Improvement Methodology

[摘要] Aims. To reduce monthly bed days for children and young people(CYP) aged under 18 years admitted to adult psychiatric beds by50%Methods. QI tools used included driver diagram, stakeholder analyses, process mapping, ishikawa diagram, pareto chart and interviews with CYP and carers to gather qualitative data. Monthlydata were collected on all admissions of CYP to adult mentalhealth beds. Change ideas/ process changes included:• Early senior psychiatric CAMHS review for all CYP admitted toadult psychiatric beds (same or next working day)• Increased access to CAMHS medical records for out of hoursstaff• Admission of all appropriate under 16’s to paediatric bedsinstead of adult mental health beds• Short test of change of staffing CAMHS specialist nurses over aweekend• Develop alternative non-health crisis support/bed for CYP• Develop Personality Disorder (PD) pathway Results.• Early senior CAMHS psychiatric review was associated with areduction in CYP admitted to adult mental health beds froma median of 20 days a month to 2 days a month without anassociated increase in CAMHS inpatient admissions• Pareto chart showed that Personality Disorder (PD) was thecommonest diagnosis• Access to CAMHS medical records for all out of hours psychiatric medical staff was increased from 13% to 100%• Routine admission to paediatrics for all under 16’s was agreedwith paediatric medical and nursing managers but not sustainably implemented• There were no acute referrals to the CAMHS specialist nursesover the single weekend short test of change• Development of an alternative non-health crisis support/bedand development of a Personality Disorder (PD) pathway isstill in processConclusion. The primary outcome measure was successfully metwith the median bed days of CYP admitted to adult mental healthbeds sustainably reduced from a median of 20 days to 2 days. Thiswas associated with the implementation of routine early seniorpsychiatric CAMHS review and increased access to CAMHShealth records for all medical staff providing psychiatric out ofhours assessments. The change ideas including development ofdifferent admission pathways (paediatrics and non-health crisisbed), weekend CAMHS specialist nurses service and developmentof a personality disorder pathway were not implemented sustainably. The pathways of care around CYP presenting in crisis arecomplex. Making sustainable improvements in complex adaptivesystems is complex and challenging but not impossible.

[学科分类] 计算机科学（综合）