emascrewThe inclusion of a specialist psychiatric acute assessment unit for patients presenting to the emergency department (ED) reduces the number of patients admitted to psychiatric wards by half, a study by Central and North West London NHS Foundation Trust (CNWL) has found.

The research poster presented at The Royal College of Psychiatrists’ Faculty of Liaison Psychiatry and Addictions Psychiatry annual conference (4 June) has been highly commended and it is hoped will encourage wider use of such units to reduce waiting times and the need for admissions to acute mental health wards.

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Dr Alex Thomson, consultant liaison psychiatrist with CNWL, said: "Often people in psychological distress present to general hospital emergency departments. Our Liaison Psychiatry Team responds to all referrals within the hour, but patients can still spend hours in an environment which does not suit their needs while waiting for hospital admission or other arrangements to be made.

"In 2013, an average of 28 people seen by our team were staying for more than four hours in the ED every month, whereas in the past 4 months there have been only 4 in total. We’ve also found that moving people out of the hectic department helps people feel better as it is a calmer environment and gives us a little more time to put things in place to support people at home. Better access to experienced psychiatrists has also meant that the need for formal Mental Health Act assessments has decreased."

Number of formal assessments decreased over 4 months
The study, developed by Harrow Home Treatment Team and Psychological Medicine Team at CNWL evaluated a specialist psychiatric acute assessment unit for patients presenting to the ED across the first 4 months of 2014.

During that time, the Liaison Psychiatry Team saw 615 patients in the ED, and 235 were assessed in the new unit. The number of patients admitted to psychiatric wards from the ED decreased by more than 50% compared with the same 4 months last year, and the number of formal assessments for sectioning under the Mental Health Act also decreased.

Montse Garcia, CNWL operational and project manager, added: "Unfortunately some patients still have to wait for long periods before leaving the unit due to the time it can take to arrange transfer to specialist beds and the complex nature of why they have presented to the ED. But patient satisfaction with the new service is high and of the patients who had previously attended the ED, 95% felt that the unit had improved their experience of the service offered."

The pilot saw a dedicated assessment unit, located within the Mental Health Unit at Northwick Park Hospital, serving all referrals to the Liaison Psychiatry Team. The unit was staffed 24 hours a day with a specialty doctor and two nurses, and supervised by a project manager and consultant psychiatrist. As a result of these findings, the pilot duration has been extended and further evaluation is planned.