A 12-month follow up of the implementation of clinical indicators in a consultation-liaison service

Clinical audit of the Consultation-Liaison psychiatric service of a metropolitan hospital

OBJECTIVE

The primary objective of this study was to use clinical indicators to track changes in efficiency of a Consultation-Liaison service as part of a clinical audit cycle.

METHODS

This was a clinical audit cycle. The auditing phase involved measuring the efficiency of the service. The 'intervention' was simply the team's awareness and involvement in tracking these statistics. Subsequently, these indicators were re-audited.

RESULTS

In the initial audit cycle, 315 referrals to the C-L service were audited over a 3 month period, showing a 24 hour time-to-seen rate of 80% and a 36 hour time-to-seen rate of 89.2%. Upon re-auditing of 112 referrals following our intervention, 24 hr timeliness had risen to 92% and 36 hr timeliness had risen to 96.4%.

CONCLUSION

The measuring of clinical indicators of efficiency in C-L may give service improvement personnel a reflection of the functionality of a C-L service. By involving team members in the measuring and tracking of these indicators, we may be able to boost overall clinical efficiency and outcomes.

Implementation of the CLiP database

PURPOSE

The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services.

DESIGN/METHODOLOGY/APPROACH

All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan.

FINDINGS

The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan.

ORIGINALITY/VALUE

Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

Benchmarking a liaison psychiatry service: a prospective 6-month study of quality indicators

Aims and Method

There are no national standards to evaluate the quality of delivery of in-patient liaison psychiatry services in general hospitals in the UK. In order to benchmark our service against best international practice, we adapted quality indicators from two peer-reviewed studies from Australia and Switzerland and monitored our performance standards over a period of 6 months.

Results

There were 145 patients assessed over the study period. We set a priori target of 90% achievement on indicators in the areas of timeliness of response to all referrals, timeliness of response to referrals following self-harm and quality of supervision of junior medical staff attaining 93.8, 87.5 and 89.6% respectively.

Clinical Implications

We demonstrated that we provided a reasonably responsive consultation–liaison service with high levels of supervision of junior staff. National bodies should develop benchmarks in this area so that services can demonstrate the quality of their service and learn from others' good practice.

Developing performance indicators for clinical governance in dimensions of risk management and clinical effectiveness

OBJECTIVE

This study has been designed and conducted to develop domestic indicators for evaluating the performance of clinical governance in dimensions of risk management and clinical effectiveness.

DESIGN

This study implemented a 5-stage process including conducting a comprehensive literature review, expert panel (∼ 1000 h per person per session, 11 experts), semi-structured interviews, a 2-round Delphi study (33 experts were in attendance) and a final expert panel (8 experts were in attendance).

SETTING

East Azerbaijan-Iran Province.

PARTICIPANTS

Fifty-six specialists and experts in different fields of medical sciences.

MAIN OUTCOME MEASURES

Importance and applicability of indicators.

RESULTS

Using a thorough literature review, 361 indicators (129 risk management indicators in 4 dimensions and 232 clinical effectiveness indicators in 18 dimensions) were found. After conducting expert panels and interviews, the number of indicators decreased to 168 cases (65 risk management indicators in 4 dimensions and 103 clinical effectiveness indicators in 12 dimensions). Two rounds of Delphi identified four indicators that were omitted. The members of the final expert panel agreed on 113 indicators (43 risk management indicators in 4 dimensions and 70 clinical effectiveness indicators in 11 dimensions).

CONCLUSION

In this study, indicators for assessing clinical governance in domains of risk management and clinical effectiveness were designed that can be used by policy-makers and other authorities for improving the quality of services and evaluating the performance of clinical governance. Those indicators can be used with slight modifications in other countries having healthcare systems similar to that of Iran.

Quality indicators for a consultation-liaison psychiatry service

Purpose

– Consultation-liaison psychiatry (CLP) researchers have not yet developed accepted quality indicators to measure efficiency or effectiveness. The purpose of this paper is to combine objective and subjective quality indicators to assess hospital-based CLP service utilisation, efficiency and effectiveness.

Design/methodology/approach

– Service utilisation rate was calculated over the service's first four years. Patient characteristics and objective quality indicators relating to response timeliness in 2012 were examined. Totally, 41 staff and 52 consecutive patients completed evaluation surveys to subjectively evaluate effectiveness.

Findings

– The utilisation rate increased initially and then slightly declined to 1.03 per cent of all hospital admissions. In 2012, 91.5 per cent were seen on the same referral day and 99.4 per cent by the next day. The benchmark for urgent referrals was not met (77.4 per cent). Patients rated involvement with the CLP service a positive experience (90 per cent), but were less clear about follow-up plans (68 per cent). Staff believed that the service improved the patients’ hospital course (98 per cent) and was communicated well (93-95 per cent). Only 63 per cent agreed that relevant CLP education was provided and 76 per cent rated follow-up plans as clear.

Originality/value

– This CLP service was evaluated by measuring utilisation rates, referral response timeliness and consumer feedback. Referral to contact time is a useful objective quality indicator but should be combined with subjective yet standardised measures surveying service recipients (patients and referring staff) to be comprehensive and meaningful.

Developing performance indicators for homeless outreach psychiatric services

OBJECTIVE

Performance indicators (PIs) aim to improve services by measuring key activities in a way that allows comparison over time, between services and against benchmarks. This paper describes the development and implementation of Homeless Psychiatric Service PIs and explores their potential benefits and limitations.

METHOD

We collected descripton of quality service from key stakeholders. We identified eight key parameters, from which PIs were developed and tested over a 12-month period.

RESULTS

The use of the PIs led to increased awareness of the practice being measured. PIs were used to stimulate practice changes. They played a positive role in team dynamics and were useful in clarifying team aims and identity. The main challenge to their use was the burden of data collection and analysis.

CONCLUSION

Homeless service PIs can assist in determining how well the programs are performing in activities that are relevant to clients and non clinical services for the homeless. With the movement of homeless clients away from inner urban areas, homeless performance measures may aid teams to develop the capacity to work effectively with homeless clients.