Authors (including presenting author) :
So SN
Affiliation :
Accident &Emergency Department, Prince of Wales Hospital
Introduction :
In A&E of Prince of Wales Hospital, there is on-site Psychiatric Consultation-Liaison(Psy CL) service with off-site psychiatrist support. The service is provided on request by doctor after medical consultation. During 2020-21, there were 1981 Psy CL referrals for psychiatric assessment, compared to 1806 cases in 2019-20 and 1515 cases in 2018-19. It shows a growing demand of psychiatric service in A&E.
Objectives :
To accelerate the referral of psychiatric patients for Psychiatric Consultation-Liaison assessment in A&E, after excluding those who need immediate medical attendance by doctor.
Methodology :
The trial period was October-November 2019. It was conducted by a senior Registered Nurse. At triage, all patients aged 18 or above who present with mental health problem were recruited during Psy CL service hours. The triage nurse used a checklist to screen suitable mental health patients who need Psy CL assessment. The checklist was developed with the consensus of A&E Department and Psy CL Team. All referrals were agreed by on-duty A&E Specialists before proceeding to Psy CL assessment. Patients were then consulted by A&E doctor after psychiatric assessment. Inclusion criteria: 1. Age 18 or above. 2. Present with mental health problem. Exclusion criteria: 1. Attend A&E with Community Psychiatric Nurse/request for psychiatric admission. 2. Triage Category 3 (Urgent) patient because of borderline vital signs according to triage guideline. 3. Present with significant physical problem/complaints, or recent medical admission. 4. Drug overdosed, or alcohol intoxicated patients.
Result & Outcome :
The trial recruited 15 patients. Ten patients were suitable for Psy CL referral but 1 patient was missing. Of the 9 patients assessed by Psy CL, 6 of them were assessed to need psychiatric treatment. Four patients needed psychiatric in-patient treatment and 2 patients had their psychiatric follow up appointment advanced. Patients were assessed by Psy CL Team while they were waiting for medical consultation, and that A&E doctors could intervene at an earlier time according to psychiatric assessment findings. The outcome is the overall journey of mental health patients in A&E is streamlined. With the early psychiatric assessment, A&E nurses can also provide more appropriate psychiatric observation to patients. Early Psy CL referral at triage could improve emergency mental health care.
