Enhancing Medical Governance of Care Within an EIP Service

AIMS: We aimed to enhance the clinical governance of medical input to patients within Brighton Early Intervention in Psychosis (EIP) service. The Service Standard Operational Policy indicates that patients should be medically reviewed every 6 months as part of the Care Programme Approach (CPA) and include review of: diagnosis, service eligibility, medication positive and negative effect, clinical improvement, risk assessment and physical health. METHODS: The EIP caseload on a specific date was reviewed to explore if a medical CPA review had taken place. A detailed medical letter evidenced this. A meeting was convened between team doctors to identify from electronic records when the last medical CPA had taken place. General characteristics of the delayed review group were identified. An excel spreadsheet was used to create a system to autogenerate when a next review is required. RESULTS: 142 patients were identified on the EIP caseload. 21 patients had been discharged so were excluded. 121 patients were eligible for this audit, including 8 inpatients. 46 (38%) patients were identified as having an overdue CPA review. Those with overdue CPA reviews were found to be overall clinically stable, on the caseload for over a year and those who had had a recent change in Lead Practitioner (LP) who were not aware of service operational policy due to high staff turnover linked with the COVID-19 pandemic. Some duplications of routine medical reviews were identified between team doctors within the 6 months. CONCLUSION: This service was not achieving CPA standards of the operational policy. A spreadsheet was set up to proactively alert the LP when patients required a 6 month review. Policy information sessions were set up for the team and will be specifically included in new worker induction training. A full audit cycle will be completed by implementing the change made and re-auditing to see if there is an improvement. Duplications of routine medical reviews will be explored in more detail.