Authors (including presenting author) :
Yuen MSY (1), Lam CYJ, (1), Leung Z (2), Chan LW (1), Kwok FY (1)
Affiliation :
(1) Department of Accident and Emergency, Pamela Youde Nethersole Eastern Hospital
(2) Department of Infection Emergency and Contingency, Head Office of Hospital Authority
Introduction :
Introduction:
Hundreds of patients attend Accident and Emergency Department (A&E) each day in which one to six presented with mental health. For interviewing with mental health patients before detention orders were made under the Mental Health Ordinance (MHO), face-to-face approaches were employed by the Judges and Judicial Officers (JJO) for decades. In view of infection control measures during COVID Pandemic and availability of information technology in hospital, telehealth approach was proposed.
Objectives :
Objective:
To report on implementation of enhancement measures in A&E
Methodology :
Method:
Telehealth was proposed by the Coordinating Committee of Accident and Emergency (COCA&E) in October 2020, support was obtained from Head Office and Information Technology Department of Hospital Authority, Department Head of 18 A&Es and Specialty Advisory Group of A&E in December 2020. The practice of interviewing mental health patients before detention orders were made by the Judges was revised, collaboration workflow between A&E and JJO was worked out.
Mental health patients required compulsory admission after Psychiatric consultation and requested seeing Judges by zoom would trigger the workflow in A&E, where they would be admitted to observation ward and cared by designated nursing staffs, verbal consents would be obtained from the patients by A&E Physicians, JJO would be contacted by nursing staffs and interviewed would be arranged. After interview, legal documents would be signed by Judges, faxed and sent to hospitals for arrangement of admission. For those requested seeing Judges in person, face-to-face interviewed would be arranged.
To prepare for the above implementation, staff education was carried out. Secretary of COCA&E liaised with JJO in December 2020, Nursing staffs and Hospital IT staffs prepared the hardware and software, designated nursing staff wrote the workflow and did the pilot in December 2020 before full implementation in December 2021. Opinions were sought from JJO and clinical departments of hospitals, handover mechanism of mental health patients enhanced. Barriers to implementation were overcome at the pilot period and prospective audit carried out at the implementation period.
Result & Outcome :
Results:
There were 156 mental health patients attended A&E from December 6th 2021 to February 7th 2022, all with psychiatric consultations. 58 (37%) patients were discharged home with follow-up, 95(61%) patients needed admission and 3 (2%) patients were discharged against medical advice.
Out of these 95 admission patients, 24(25%) patients were admitted to general ward, 48 (51%) patients were admitted on voluntary basis and 23(24%) were admitted under detention order of MHO to Psychiatric ward. For the detention order group, only 10 requested seeing JJO whom 8 fulfilled the Telehealth criteria and zoom interview were arranged. The overall compliance to new workflow were 100%. Workload were regarded acceptable form staffs’ surveys. Implementation was smooth and new measures were welcomed by patients, relatives, JJO and clinical departments.
Conclusion:
Through collaboration between A&E and JJO, the enhancement measures were feasible and results in significant improvement in interviewing mental health patients under detention order of MHO by Telehealth in A&E.
