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Kids Acute Liaison in Mental Health

The Children's Hospital at Westmead
Project Added:
19 August 2014
Last updated:
26 September 2014

Kids Acute Liaison in Mental Health (KALM)

The Children’s Hospital at Westmead

Summary

The Kids Acute Liaison in Mental Health (KALM) project established a clear pathway and guideline for all Mental Health (MH) presentations to the Emergency Department (ED). This improved collaboration between the ED and Psychological Medicine, ensuring patient care was always the prime focus. This also helped eliminate lengthy delays for patients which in turn improved the National Emergency Access Targets (NEAT).

Download a poster about this project from the Centre for Healthcare Redesign graduation, August 2014.

Aim

To measurably improve the model of care for children and adolescents presenting to The Children’s Hospital at Westmead ED requiring urgent mental health care.

Benefits

  • Improved care triage, assessment and disposition of mental health patients presenting to the ED.
  • Consistency in care provided to all mental health patients.
  • Timely care provided to Mental Health patients in the ED.
  • Improvement in NEAT.
  • Increase cost effectiveness in treating mental health patients in the ED by limiting waste from excessive waiting.
  • Improved collaboration and communication between the Psychological Medicine Department and Emergency Department.

Background

Data shows a 120% increase in mental health presentations to the emergency department at the children’s hospital over the last 10 years and research has suggested that this figure will only continue to increase.

There has been a change in the nature of presentations to the ED. Self-harm and suicidal ideation made up 50% of all mental health presentations in 2012 compared to 20% in 2002.

There was no standard model of care for Mental Health presentations to the ED as there was no clear pathway or guideline.

A lack of collaboration and communication between psychological medicine and the emergency department was evident as well as inconsistency in care provided to mental health patients in the ED.

The introduction of NEAT for all emergency presentations in New South Wales indicated a need to improve performance.

Solutions implemented

  • Introduction of a new model of care for all mental health presentation in the ED (KALM Pathway)
    • All mental health patients to be assessed by the ED medical staff and assign status
    • Standard assessments including HEADSS (a psychosocial interview for adolescents - Home & Environment, Education & Employment, Activities, Drugs, Sexuality, Suicide/Depression), a Mental State Examination (MSE) or a risk assessment to be completed at this time
    • ED staff to manage all low status patients
    • Psychological Medicine to manage all high status patients.
  • Introduction of key performance indicators (KPIs) for response time to ED consultation
    • Psychiatric consultations to respond to ED either in person or phone within 60mins
    • Psychiatric registrars to respond to ED phone calls within 30mins
    • Psychiatric registrars to attend ED in person within 60mins
  • Fortnightly meetings between the management of both departments to increase collaboration and communication.
  • Weekly auditing of all mental health presentations during trial period with regular feedback given to management.
  • Development of information packages and tools for implementation and maintenance of KALM pathway
    • Education provided to all ED staff and psychiatric registrars and consultants.

Results

By auditing and analysing data from the 8 weeks of the project trial.

  • Significant improvement in the collaboration between the two departments in the assessment and treatment of MH patients in the ED. This work is now shared equally by the two departments resulting in better care and less delays for MH patients
  • There has been improvement in Psychological Medicine response time to ED consultation and attendance meeting the KPIs set for the project
  • By the end of the trial the pathway was followed 89% of the time
  • When pathway was followed the NEAT target was achieved 100% of the time over the last three weeks
  • The ED medical staff conducting a brief HEADSS/MSE assessment on all MH patients by the end of the trial as per KALM pathway guideline.

Lessons learnt

  • Temptation to be expedient rather than efficient.
  • Clear and concise communication is paramount to any project success.
  • Always remember best patient care.
  • Collaboration between stakeholders is essential.  

References

Klein, D.A., Goldenring, J.M., and Adelman, W.P. (2014). HEEADSSS 3.0 The psychosocial interview for adolescents updated for a new century fuelled by media. Contemporary Pediatrics

Parker, A.G., Hetrick, S.E., and Purcell, R. (2010). Assessment of mental health and substance use disorders in young people: Refining and evaluating a youth-friendly assessment interview. Australian Family Physician, 39, 585-588.

Contact


Project Manager KALM/Research Psychologist
The Children’s Hospital at Westmead
Phone: 02 9845 0412

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