Dr. Ranjitha David, Specialty Registrar, NHS Tayside.

Dr. Mandi Marshall, Consultant Psychiatrist, NHS Tayside

METHOD:

All in-patient discharge records on the electronic system Midis were reviewed to

obtain information on ESDs taken on by the AMHRT and CRHT. All ESDs between

May 2103 and April 2014 from the adult in-patient wards in Dundee were included

in the review.

RESULTS:

1.The records showed that between May and October 2013, fifty one patients were

taken on for ESD by the AMHRT and between November 2013 to April 2014, thirty

two patients were taken for ESD by the CRHTT.

Number of ESDs taken on by AMHRT and CRHTT

2. The average number of bed days utilized per patient on ESD before November

2103 was 28.29 days per patient and from November onward, the average reduced

to16.09 days per patient.

Comparison of bed days utilized

BACKGROUND:

Early supported discharge (ESD) describes a pathway of care for people transferred

from an inpatient environment to a primary care setting to continue a period of

recovery at an almost similar level of intensity, and delivered by staff with the same

level of expertise as that of an inpatient setting. Its aims to allow patients to return

home from hospital earlier than usual and continue their recovery at home.

The key functions of the Crisis Resolution and Home Treatment team (CRHTT) in

Dundee are gate keeping acute inpatient admissions, offering a meaningful home-

based alternative to acute inpatient admission and facilitating early discharge from

acute inpatient wards (1).

The CRHTT was formed in November 2013, prior to which it was a nurse led service

called the Acute Mental Health Response Team (AMHRT). Unlike the CRHTT the

AMHRT did not adopt strict screening criteria for patients taken on the case-load for

ESD.

AIMS:

To look at the number of patients taken on ESD from the wards by the Dundee

CRHTT since November 2013. To determine the average number of in-patient stay

days before the patients were placed on ESD.

To compare the ESDs taken on by AMHRT and CRHTT team in terms of number of

patients and average number of in-patient stay days.

To determine the number of patients who had relapsed when on ESD and had

required re-admission.

To determine the average duration of follow up when on ESD and the outcomes after

contact with CRHTT ended, i.e; discharged to the care of GP, CMHT etc.

Review of Early Supported Discharges taken on by the Crisis

Resolution and Home Treatment Team in Dundee

3. The average duration of follow up of patients by the AMHRT was 16.31 days and

the average duration of follow up by the CRHTT was 15.5 days.

Average duration of follow up of patients

4. Out of the fifty one patients taken on by the AMHRT five had suffered relapses

and had to be re-admitted. Out of the thirty two patients taken on by CRHTT three

had to be re-admitted due to relapse. The remaining outcomes such as discharge

to GP, CMHT follow up and other outcomes ( Alcohol service, drug problem service

and psychology ) are depicted in the figures below.

AMHRT Outcomes CRHTT Outcomes

DISCUSSION:

The review clearly showed a decrease in ESDs following the streamlining of criteria

for patients taken on for support following discharge. Adoption of strict criteria for

ESD might prove to be a good method to reduce inappropriate referrals to the team,

and also allow for resources to be utilized appropriately.

One of the main aims of the review was to determine the usefulness of ESD in terms

of reduction in the number of in-patient stay days on the wards, and the results

revealed that this aim was definitely met by the CRHTT. The team was successful in

reducing the average number of bed days by approximately 12 days as compared to

the AMHRT. The average duration of follow up and the relapse rates were however

similar for both teams. It should be highlighted that only a small minority of patients

had suffered relapses (ten percent), which suggests that home treatment might be an

effective means of intervention for suitable patients.

ESD is thought to have several advantages for patients in that it allows them to return

to the comfortable environment of their own home before the end of their actual

admission with quite intensive staff support. This is also thought to improve patient

satisfaction and might facilitate earlier recovery.

ESD would prove to be the least restrictive option for several patients especially when

they are already on the path to recovery. ESD would also be a cost effective option in

comparison to hospitalised care for several patients who are not at imminent risk and

can be managed in the community. This method of supporting patients in the

community would certainly involve collaborative working between various teams such

as the in-patient teams, CMHTs, Home treatment teams and primary care to ensure

high quality care delivery.

REFERENCE: Cresswell J , Hodge S , Hailey E. Home Treatment Accreditation Scheme (HTAS) , Standards for

Home Treatment Teams First Edition: Royal College of Psychiatrists. 2013 Feb; Section 1, page 4.

Acknowledgements to Katie Garrigan third year nursing student at University of Abertay for data

collection