Physical Healthcare of Inpatients in Mental Health Hospitals

This study has been commissioned by the Healthcare Quality Improvement Partnership
as part of the Clinical Outcome Review Programme into Medical & Surgical care, as part of the current contract awarded in 2015
For information on how we use data click here

Data collection for study: Due to start in February 2020
Publication date:       Summer 2021   

Aim: To identify and explore remediable factors in the physical healthcare of adult patients admitted to an inpatient mental health facility.

Objectives:

Organisational:

To review the provision of services, organisational structures and the policies in place to facilitate the delivery of care to meet the physical health needs of this group of patients.
Focus will be placed on the systems, processes and facilities in place for the:

 
• Identification, assessment and monitoring of patients with (or at risk of developing) physical health conditions, including withdrawal from substance misuse
• Safe, appropriate and effective treatment of physical health conditions including access to preventative care and treatment for acute and long-term physical health conditions
• Support for patient and carer involvement in care-planning, health education and self-management of potential or identified physical health needs
• Safe and continuous care including the pathways for (and actual ) follow-up of identified physical health needs throughout the patient’s in patient stay and on discharge from a mental health inpatient admission including:
    - Timely escalation in the level and/or intensity of care provided to individuals with identified physical health conditions including transfer to other acute care settings
    - Access to appropriate expertise and services for healthcare in or outside of the inpatient unit for the care of acute and long-term physical health conditions
    - Discharge-planning and follow up arrangements for identified physical health needs by primary and secondary physical health care providers
    - Mechanisms to support continuity of care over the entire course of an admission including transfers to other care settings
• Communication and sharing of relevant information, including physical health history, care plans and medication records.
    - Between the patient, clinical teams and (as appropriate) carers/ family
    - Between different healthcare providers: general hospitals, primary care, dentists, allied healthcare professionals, community mental health providers and inpatient mental health providers
• Safe prescribing and monitoring of medication including reconciliation in event of transfers between care settings and at point of discharge
• Training, competences and the confidence of healthcare professionals in the delivery of physical healthcare for those who are at risk of or have a known physical health condition/s
• Application of the Mental Capacity Act: has the MCA been used appropriately in decisions and actions taken in relation to the physical health care, needs or risks of the patient

Clinical:

To identify and review remediable factors in the overall quality of care provided, with a particular focus on the following areas:

• Access to physical health care within the inpatient mental health setting including
    - Identification, monitoring and management of modifiable disease risk factors, the prevention of physical illness and the management of long-term physical conditions throughout admission
    - Timely referral to (and review by) specialist physical health care provider where appropriate
• Communication and sharing of essential information, including medical history of physical health, care plans and medication records.
    - Between the patient, clinical teams and as appropriate carers/family
    - Between different healthcare providers: general medical hospitals, primary care, dentists, allied health professionals, community mental health providers, inpatient mental health providers
• Evidence of inappropriate or delayed interventions and/or escalation of care to another specialty or physical healthcare setting
• Evidence of any missed opportunities to intervene in patients at risk of developing a long term physical health condition
• Management of medications including reconciliation and possible interactions, concordance, adherence, therapeutic drug monitoring and appropriate counselling
• Care planning with community, primary and secondary care for safe discharge and arrangement of follow up for identified physical health needs
• Application of the Mental Capacity Act 2005 and assessment of capacity and consent for treatment for physical health needs
• The overall standard of care and treatment provided and its equivalence where possible, to care received by patients without mental health conditions

Participation:

All inpatient mental health hospitals in England, Wales, Scotland, Northern Ireland, Channel Islands and Isle of Man, where patients are receiving healthcare for a time limited period for a primary mental health condition with expectation of discharge to an alternative setting.

NB. Please see the study protocol for more information.
We will be asking all acute general Trusts/Health Boards to submit a data collection spreadsheet to help us identify patients who have been transferred from a mental health hospital to an acute general hospital.

Data collection:

A patient identifier spreadsheet will be sent to all inpatient mental health hospitals in mid-February 2020.
Another patient identifier spreadsheet will be sent to all acute general hospitals in mid-February 2020.
Both spreadsheets are currently being piloted.

Study protocol:

The study protocol can be downloaded from the Download Links section on the right.

Clinician/organisational questionnaires:

These will be disseminated electronically in due course.

Case reviewers:

We are currently recruiting case reviewers for this study, please see here for further details

Further questions about the study may be directed to:phmh@ncepod.org.uk