Creating efficiencies in the acute care pathway: the rapid assessment, treatment and discharge approach

Pages50-55
DOIhttps://doi.org/10.1108/13619321111157981
Publication Date17 Jun 2011
AuthorAlexis Bowers,Elham Aldouri
SubjectHealth & social care
Creating efficiencies in the acute care
pathway: the rapid assessment,
treatment and discharge approach
Alexis Bowers and Elham Aldouri
Abstract
Purpose – Despite contemporary mental health services shifting to a community-based model of care,
acute inpatient care is still necessary for many patients experiencing an acute psychological crisis.
As inpatient services cost the National Health Service nearly £600 million a year,initiatives to reduce time
spent in hospital, whilst maintaining safety and quality, are being actively promoted on a national level.
Mental health patients in Hertfordshire spend on average two weeks in hospital during their acute crisis.
The aim of this study is to reduce bed occupancy rates by implementing a novel approach to inpatient
management.
Design/methodology/approach – A pragmatic controlled clinical trial design was used to address the
aim of this study.
Findings – The results demonstrate that, compared to a functionalized inpatient ward (one with a
designated inpatient consultant psychiatrist conducting a weekly ward round), it is possible to reduce
bed occupancy rates without increasing demand on other wards. Furthermore, 28-day readmission
rates and total admissions over seven days were reduced.
Research limitations/ implications – Limitat ions relating to the study d esign and potential
generalisability to similar services are discussed. Further studies to triangulate the data are suggested.
Practical implications This novel approach to inpatient management provides exciting data that
suggest patients can be moved along the acute pathway more efficiently. Recommendations for further
studies are made in light of the findings.
Originality/value – This paper will appeal to acute care clinicians, se rvice managers, and
commissioners of mental health services. It provides an evidence base for making efficiencies within
the acute service whilst maintaining quality of care for patients.
Keywords Inpatient, Acute care pathway,Efficiency savings, New ways of working, Medical treatment,
Mental health services
Paper type Research paper
Introduction
Acute adult inpatient services cost £585 million per year (Mental Health Strategies, 2010).
Given the significant variation between Trusts in how beds are utilized, this area of mental
health service provision has become a target for provider organizations and commissioners
to meet the efficiency savings that are required from the government’s most recent
comprehensive spending review (Naylor and Bell, 2010).
Seventeen years ago Thornicroft and Strathdee (1994) highlighted efficiencies that could be
made within the inpatient service. Some recommendations have been promoted, for
example, the need for home assessment that has been nationally rolled out in the form of
home treatment teams. However,many have fallen by the wayside. For example, they called
for frequent inpatient review meetings that are led by senior clinicians. Unfortunately,up and
down the country, weekly ward rounds for patients are still the norm. Junior doctors are still
admitting patients to wards ignoring Thornicroft and Strathdee’s call for senior clinicians to
front load the acute service and gate-keep all admissions. Without a doubt, the explosion of
PAGE 50
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MENTAL HEALTHREVIEW JOURNAL
j
VOL. 16 NO. 2 2011, pp. 50-55, QEmerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/13619321111157981
Alexis Bowers and
Elham Aldouri are
Consultant Psychiatrists
working for the
Hertfordshire Partnership
NHS Foundation Trust,
St Albans, UK.

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