Two projects aiming to relieve pressure on busy services

Two projects, supported through our Innovating for Improvement programme, have been testing new approaches to help provide more responsive care to patients and relieve pressure on services, pressures which often become most visible and acute during winter.

1. Introducing telepsychiatry in an emergency department psychiatric service

In Oxford the challenges for a psychiatric service assessing patients across two emergency departments, 25 miles apart, were significant. Patients presenting with psychiatric issues at Horton General Hospital often had to wait over an hour to be seen by the Emergency Department Psychiatric Service (EDPS), which is based at the John Radcliffe Hospital. Discharges could be delayed and valuable staff time was taken up with travelling between sites.

Telepsychiatry – the use of video conferencing to deliver mental health services – has been used in other countries such as Australia, Canada and the USA, initially to provide services to remote communities, but increasingly, because evaluations show that patients like it. EDPS (part of Oxford Health NHS Foundation Trust), in partnership with Oxford University Hospitals NHS Trust, is now using this technology, which has yet to be widely adopted in the NHS, to offer an alternative service to patients and the option of quicker and easier access to care.

During the initial trial, telepsychiatry was used via tablet computers at each hospital, to get senior medical opinion on complex cases and to carry out complete assessments in the emergency department, as well as to provide follow-up appointments where clinically appropriate, using the patient’s own phone, tablet or computer.

Despite initial reservations from both patients and clinicians, patients surveyed as part of the trial reported high levels of satisfaction. 90% rated their experience of using the technology as ‘good’ or ‘excellent’. Where patients used the technology for follow-up sessions, this satisfaction figure was 100%.

Telepsychiatry is now part of EDPS’s regular service. They have carried out over 200 new patient assessments using the technology, and are increasing access to their follow-up clinics, offering appointments at weekends and in the evenings as out-patient rooms are not required.

Dr Kezia Lange, Consultant Psychiatrist, says: ‘We’ve seen really positive results from using the technology to reduce travel between our sites. Importantly, we’ve estimated that in a year this has freed up over 400 hours of clinicians’ time. That’s time that could be spent with patients instead of in a car, and patients aren’t waiting around in the emergency department to be seen. We’ve also seen cost savings, as well as managing to reduce our environmental impact. We were given a national award last year for sustainable development!’

The organisation is now looking at ways that this technology could be rolled out to other teams.

2. Bringing CAMHS closer to home: Developing community pharmacies to support medication monitoring in children and young people

Nationally, child and adolescent mental health services (CAMHS) teams are struggling to meet increasing demands on their services. Feedback also suggests that families want locally delivered services. A project led by Sussex Partnership NHS Foundation Trust aimed to alleviate some of the pressure, and improve services by training local community pharmacists to support children and young people in their area.

Children and young people prescribed medication for attention deficit hyperactivity disorder (ADHD) and related conditions need regular monitoring of their height, weight, blood pressure and pulse. In Sussex this happened at the CAMHS clinic, often meaning missed school and work, unnecessary appointments where there was no clinical need, and added pressure on the service which led to missed monitoring targets. The project provided training for pharmacists in the New Forest CAMHS catchment area to carry out the monitoring instead, and consenting families selected a pharmacy where they could go to have relevant measures taken at a convenient time.

Promising results saw increased numbers of children and young people engaging with medication monitoring, and receiving improved quality of care closer to home. Of those eligible, 90% stayed actively involved in the project. Outcomes for the service improved too, with medication monitoring and review improving dramatically. 

Also, the team discovered that significant staff time was freed up due to reduced need for clinic-based physical monitoring, thus allowing more time for specialist clinicians to support those with greater needs.

Dr Subha Muthalagu, Consultant Child and Adolescent Psychiatrist tells us: ‘Key to the success of this project was working together as a team with all our stakeholders, involving service users from the beginning, and having them help co-design the service. We also carried out a mini-pilot prior to starting the project. This meant we went into the project already with overwhelming support, and an improved care model, reflecting stakeholder feedback. Families like the choice and flexibility that this care model offers and are keen for the service to continue in the future’.

This innovative care model is now embedded in the New Forest CAMHS service with plans to expand in other areas so that more children and young people can benefit.