Authors: (including presenting author): :
So SN
Affiliation: :
Accident & Emergency Department, Prince of Wales Hospital
Introduction: :
In the Accident & Emergency Department (A&E) of Prince of Wales Hospital, there is on-site psychiatric nursing consultation-liaison (CL) service with psychiatrist support and supervision. This on-site service is necessary to improve the quality of emergency mental health care and manage acute risks to the patient and others. The service is provided upon doctor’s request after medical consultation. Is it possible to speed up the process of referral for CL team assessment if triage nurses encounter with patients present with mental health problem?
Objectives: :
To accelerate the referral of mental health patients for psychiatric consultation-liaison team assessment in A&E after excluding those requiring immediate medical attendance
Methodology: :
At the triage station of A&E, if a patient presents with mental health problem, the triage nurse will initiate psychiatric CL service request. The request is made during psychiatric CL service hours if verbally agreed by on-duty A&E specialist doctor. After psychiatric CL team assessment, the patient will undergo medical consultation by A&E specialist doctor. Trial period: 2 Oct – 30 Nov 2019. Inclusion criteria: 1. Age 18 or above 2. Present with mental health problem. Exclusion criteria: 1. Attend A&E with Community Psychiatric Nurse/ requests for psychiatric admission/ presenting with suicidal idea 2. Triage category 3 (urgent) patients because of borderline vital signs according to triage guideline 3. Present with significant physical injury 4. Drug overdose/ alcohol intoxicated
Result & Outcome: :
Totally 15 patients were recruited. Ten patients met the inclusion criteria so were referred to the psychiatric CL team at triage but 1 patient was missing. The average time from patient registration to receiving psychiatric CL service was 29 minutes. Of the 9 patients seen by psychiatric CL team, 6 of them have psychiatric input. Four patients were suggested to admit to psychiatric in-patient unit and 2 patients had their psychiatric follow up appointment advanced. Nurse-initiated psychiatric CL referral at triage has potentials to benefit patients with mental health problems. Patients are assessed by psychiatric team when they are queuing for medical consultation, and that A&E doctors could intervene at an earlier time according to the psychiatric assessment findings. The outcome is we could further improve the quality of emergency mental health care to the patient and others.
