25 August 2017
Extending liaison psychiatry service at the Bristol Royal Infirmary improves care and reduces costs for self-harm patients
Extending the operating hours of the liaison psychiatry service
at the Bristol Royal Infirmary's (BRI) Emergency Department has led
to improved care and outcomes for patients who have self-harmed,
NIHR-funded research has found. Self-harm is a strong risk
indicator for suicide, so getting psychiatric support for these
patients has the potential to save lives.
The findings, published in
BMJ open, also show that, over a three-month period, the
initial investment in the extended service may have led to a saving
of £36,150 in emergency department and hospital costs, for this
specific group of patients. This equates to £144,600 annually.
In 2014, Bristol Clinical Commissioning Group commissioned
University Hospitals Bristol NHS Foundation Trust, which runs the
BRI, to extend the operating hours of its liaison psychiatry
service. The service was extended because most emergency department
patients who have self-harmed present outside office hours.
The service change, improving levels of liaison psychiatry team
cover from 40 hours over five days to 98 hours over seven days a
week, needed an additional investment of around £250,000 per
year.
The University of Bristol researchers focused on the impact of
this service change on self-harm patients because they make up a
high proportion of the liaison team's workload, are the patient
group at highest risk of suicide and have detailed data collected
about their care through the local self-harm register. It was this
detailed data that made this evaluation possible. They also may
have to wait in the emergency department or be admitted to hospital
if they can't have a timely psychiatric assessment.
Following the service extension, about 10 per cent more patients
received a psychosocial assessment. The waiting time for an
assessment decreased by more than three hours. In 2015 with the new
hours in place, patients were 20 per cent less likely to re-attend
for self-harm within 90 days.
However, because the study only covered a short three-month
period and relatively small number of patients, these results are
preliminary. A larger study is needed to provide stronger evidence
on costs and re-attendance.
The findings will help commissioners across England judge
whether further investment in liaison psychiatric services
represents value for money, though more research is needed.
Salena Williams, who leads the psychiatric
liaison team at the Bristol Royal Infirmary, said: "It is fantastic
to have this evidence to support the investment that we convinced
our local commissioners to make. Our team has been collecting data
about self-harm patients for several years. The data was telling us
that our service wasn't covering the times when most patients who
self-harm present, leading to them falling between the cracks. As
self-harm is a strong indicator for suicide, it's vital that we
help these people at the first available opportunity. The service
extension has allowed us to do just that - and this evidence shows
that there are potential financial savings too."
Brent Opmeer, who led the research, said: "While this study was
only able to look at one group of patients over a relatively short
period of time, it's promising evidence that investment in
psychiatric liaison services not only saves money, but improves
outcomes for a vulnerable group of people. We hope to work with the
psychiatric liaison team at the BRI to assess the impact more
comprehensively."
This project was a collaboration between the National Institute
for Health Research Collaboration for Leadership in Applied Health
Research and Care West (NIHR CLAHRC West) and
STITCH, the Bristol Health Partners Health Integration Team
(HIT) that focuses on improving care for people who self-harm.
Paper
'Extending the liaison psychiatry service in a large hospital in
the UK: a before and after evaluation of the economic impact and
patient care following Emergency Department attendances for
self-harm', Brent Opmeer, Will Hollingworth, Elsa Marques,Ruta
Margelyte, David Gunnell. Published in BMJ Open
Link to paper: Extending the liaison psychiatry service in a
large hospital in the UK: a before and after evaluation of the
economic impact and patient care following Emergency Department
attendances for self-harm'
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