Creating efficiencies in the acute care pathway: the rapid assessment, treatment and discharge approach

Abstract

PurposeDespite contemporary mental health services shifting to a community‐based model of care, acute inpatient care is still necessary for many patients experiencing an acute psychological crisis. As inpatient services cost the National Health Service nearly £600 million a year, initiatives to reduce time spent in hospital, whilst maintaining safety and quality, are being actively promoted on a national level. Mental health patients in Hertfordshire spend on average two weeks in hospital during their acute crisis. The aim of this study is to reduce bed occupancy rates by implementing a novel approach to inpatient management.Design/methodology/approachA pragmatic controlled clinical trial design was used to address the aim of this study.FindingsThe results demonstrate that, compared to a functionalized inpatient ward (one with a designated inpatient consultant psychiatrist conducting a weekly ward round), it is possible to reduce bed occupancy rates without increasing demand on other wards. Furthermore, 28‐day readmission rates and total admissions over seven days were reduced.Research limitations/implicationsLimitations relating to the study design and potential generalisability to similar services are discussed. Further studies to triangulate the data are suggested.Practical implicationsThis novel approach to inpatient management provides exciting data that suggest patients can be moved along the acute pathway more efficiently. Recommendations for further studies are made in light of the findings.Originality/valueThis paper will appeal to acute care clinicians, service managers, and commissioners of mental health services. It provides an evidence base for making efficiencies within the acute service whilst maintaining quality of care for patients.