Associate Professor Tim Wand1, Mrs Nerida Bell2
1Sydney Local Health District, Sydney University, Sydney, Australia, 2Royal Prince Alfred Hospital, Sydney , Australia
Presentation rates to Emergency Departments (ED) of people with mental health, drug health and behavioural concerns have significantly increased, and are greater than the overall increase of ED presentations generally. Additionally, ED length of stay is disproportionally longer for this group of patients. Internationally it is accepted that long stays for all ED presentations is associated with poorer health outcomes and greater incidence of adverse events.
This multi-site translation research project aims to implement and evaluate an innovative model of mental health nursing care in three EDs across New South Wales (NSW) Australia. During the pre-implementation phase of the project three focus groups and 15 individual interviews were conducted with ED staff, hospital executives, psychiatrists and mental health executives. Four themes were identified as barriers or challenges to providing suitable care for this patient group.
- Timeliness and efficiency
- Resource allocation and specialist skills
- A change in thinking a practice
- Culture and relationships between disciplines and services
The proposed model of care for this study involves integrating a team of specialist mental health nurses within in the ED structure. A previous trial demonstrated a positive impact on all four of the above identified themes in one urban tertiary hospital. However, translating these findings and implementing the model in three divergent settings surfaced numerous challenges. Lengthy documentation and decision making processes, outdated governance structures and a silo-mentality were evident. There is no question that a change in the way care is delivered to people with mental health, drug health and behavioural problems in the ED is required. Rather than simply focusing on additional resources, an alternative way of thinking and working is required to improve patient outcomes and ED service provision.
Tim Wand is an associate professor with the Sydney Local Health District and the University of Sydney and a nurse practitioner in mental health liaison in the Emergency Department at Royal Prince Alfred Hospital.