High Intensity User Quality Improvement Project

AIMS: To ensure that patients who are high intensity users of acute mental health services (136 suite, Liaison, and inpatient admissions) have a ‘safety plan’ in place .This should contain person centred and specific recommendations to avert crisis and guide acute clinicians in managing care in a crisis situation. METHODS: Audit of electronic health care records of top 10 patients who most frequent attend each of s136 suite, LPS and inpatient wards (26 in total) in the period 05/2021 to 04/2022. Process mapping Driver diagram Coproduction via patient engagement team Focus group-across care groups and lived experience RESULTS: Process mapping – visual representation of crisis planning process within CPA process. Driver Diagram – primary and secondary drivers leading to change ideas of: additional ‘HIU response plan’ template; best practice example to guide care coordinators; process of flagging up HIU to community mental health services. Focus group – themes included the importance of : joint working across care groups’ transparency with patients regarding professional opinion; consistency of interventions during a ‘crisis’; and coproduction of safety plans. HIU response plans are incorporated into the safety plans of 20/26 HIUs. PDSA process ongoing – quality assurance and clinical effectiveness of changes to be reviewed. Further change ideas sought through QI process. CONCLUSION: High intensity users who often present in ‘crisis’ to acute mental health services, have unmet needs. This cohort require an additional framework to meet their needs. When patients experience a mental health ‘crisis’, a consistent and clear treatment response is experienced as helpful. Safety/crisis planning is thus an important aspect of meeting needs. HIU response plans’ can be incorporated into a patients ‘safety plan’ to ensure that individualised and specific guidance is available. Best practice example of ‘HIU response plans’ can empower community mental health colleagues to co-produce such plans.