Faculty of Liaison Psychiatry – RoyalCollege of Psychiatrists

JISC UPDATE November 2012

Shared care ward experience

A Liaison psychiatrist asks: ‘Kent and Medway Acute Trusts are interested in considering the use of some Shared Care Wards, most likely for complicated cases of physical health and delirium/cognitive impairment.

Does anybody have experience of this model and would anybody be willing to share an operational policy or protocols?

We would be particularly interested as to how the RMNs interface with the RGNs and the management structure(s) associated with this.’

One respondent noted quite a difference between shared care wards for the elderly and the more general medical. The person much experience of the latter is Chris Ryan fromAustralia. There is also a short bibliography in an article Dave Protheroe wrote for The Psychiatrist some years ago.

Another respondent said there had been a vogue e.g. Tom Arie’sward in Nottingham many years’ ago; but now putting liaison psychiatric staff into medical wards seems to be more popular (latterly influenced very much by Sharon Inouye's work). He also suggests speaking to John Holmes (who said ‘Gateshead and York both have shared care wards for older people. The York contact is Lance Middleton’)in Leeds or Ian Anderson from Liverpool as two old age liaison psychiatrists.

Assessment forms, outcome measures and data sets for Liaison

I (JG of Worthing!) find these discussions can get a bit confusing. On the one hand, with commissioners looking for important things to purchase we need to say ‘here is my essential product, this is how much you need and this is the unit cost – and here is the evidence that I have provided it’. We also have computerised systems with which to write up our assessments (the meat of what we do) – which are related to outcomes, but different. If only the complex clinical activity we do (quick response time, full assessment, diagnosis, care plan, educating staff etc etc) - and record - automatically generated the invoice! And the trouble with HoNOS is that there is a before and after requirement – but we often just see the once in Liaison.

Anyhow, this was the discussion (and one which we have had often on this site).

One liaison service (which uses Rio) has negotiated a formal agreement with their governance department(via a trust-wide Liaison Clinical standards group) that they use a minimum data set assessment as opposed to full RIO recording and also that we do not use FACE in Liaison.

They are building in the ability to upload this assessment (written as a word template) without the need for cutting and pasting. It then also forms a letter to GP and can be put into acute hospital medical notes.

They have a current narrative tool (as an alternative to FACE) identifying static/current risks, external hazards and mediating factors and a narrative formulation and plan. Assuming it is approved and it has a lot of internal impetus, this will be able to be used in certain other clinical settings (e.g. by on-call medics, in A&E, or for those people who are only seen in CMHT outpatient clinics with non-enhanced care needs).

A clinician’s thoughts on Rio: This service is not going live on RiO until late 2013 and is looking for agreement about when and how Liaison uses it, ‘as the figures in terms of workload is worrying to me i.e. reduction in "productivity" by 30 to 50 %’.

He wonders if data on diagnosis, physical co-morbidities, number of attendances and admissions, number of bed days, need for ‘specialling’ would make the beginnings of a useful data set.

‘I was also a bit surprised that many of the Liaison services using RiO do not use it to keep track of things like response times...it seems to me that the wait list function in RiO may be best at this and this is what I will be exploring...any other experiences out there?’

Two South London Liaison Psychiatrists are in the process of finalising a version of HoNOS for use in liaison; with Dr Mick Jones (who has been involved with developing the original HoNOS). This will be presentedat the liaison executive meeting for comments. They then plan to consult more widely amongst our peer group, before trialling it in a more structured way.

Respondents from Australia and Kent were both keen to trial this new tool when available.

Jackie Gordon

Worthing