G312(P) An emergency department based children's mental health liaison service. (May 2019)

• Record Type: Journal Article
• Authors: Ranasinghe, DSD; Thyagarajan, R; Simango, J; Walker, A
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A128
• Page End: A128
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.303
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: To measure the safety, quality and cost-effectiveness of a child and adolescent mental health service (CAMHS) embedded in a paediatric emergency department (PED). Methods: A prospective interventional study. Children and young persons (CYP) aged up to 16 years presenting to the PED with a psychiatric emergency during Monday to Friday between the hours of 0800 to 2300 were assessed by a CAMHS clinician based in the department over a 3 month period. Admission, discharge and breach rates were recorded. Qualitative measures on satisfaction were also obtained through the use of a self-reporting questionnaire issued to the CYP and their carer. Staff satisfaction was also obtained through a web-based survey. Results: A total of 103 CYP attended during the 3 month period. 49 (47%) presented during the hours of intervention and 41 (84%) of these were assessed by the PED CAMHS service. 34 (83%) assessed by the service were deemed safe for discharge with appropriate follow up plan, and 7 (17%) were admitted to the paediatric ward for further psychiatric assessment. The PED CAMHS service had a 4 hour breach rate of 20%. CYP presenting outside of intervention hours were admitted for CAMHS assessment as per existing pathway. CYP, carer and staff satisfaction was overwhelmingly positive. 96% of CYP reported that they were happy with the service with an overall satisfaction rating by CYP and their carers of 4.45/5 (89%). PED staff reported that they saved 10 hours per shift and 3 hours per patient due to the presence of the embedded service. Cost analysis demonstrated a saving of £12 920 through the avoidance of admissions. There were no serious untoward incidents. Conclusions: CYP presenting to PED with acute psychiatric conditions requiring urgent mental health assessments are increasing. This intervention provides evidence to suggest that such a service could be safe and cost effective. The intervention improved the quality of service that CYP and their carers experienced with timely assessments and interventions. Establishing a comprehensive service within PED may reduce the disparity between physical and mental health provision for CYP in psychiatric crisis in addition to improving their long term outcomes.