Perth Royal Infirmary Liaison Service

What was the issue you were addressing or working on?

Improved access to dementia liaison services in Perth Royal Infirmary to improve the knowledge and skills of nursing, AHP and social work staff which will improve the management and care  of patients with dementia / delirium in a general hospital environment and within the community.

Proactively identify patients with a cognitive impairment who would benefit from early supported discharge.

What you did?

Enhanced the PRI Dementia Liaison Service by 1 WTE Team Leader Nurse and 1 WTE Occupational Therapist in addition to the original B6 Mental Health Nurse.  The enhanced service commenced September 2011.

The main aims and objectives of the service was to:

  1. Team Accessibility and Visibility: Creation of a single point of access to specialist liaison services to improve the accessibility of the team, resulting in a reduction in waiting times incurred by patients referred to the service.
  2.  Early Identification: To undertake early identification of patients experiencing difficulties with memory or mental health difficulties by shifting from a reactive process to a proactive referral process. This ensures more effective support for patients within the Acute Hospital setting, so that their care needs, goals and discharge outcomes can be appropriately identified and met.  Thus a timelier and more effective supported discharge is achieved.  An essential aspect of the team’s role is sign posting and referral to appropriate services to enable the effective follow up of care or treatment leading to an earlier diagnoses for people with dementia.
  3.  Transitional Care following discharge: The Liaison Team will provide a period of transitional care for patients referred to the Team who meet defined rehabilitation criteria following their discharge from hospital.  This model’s overall aim is to improve the patients’ journey including their post discharge care, through the facilitation of a timely and effective discharge and to prevent inappropriate readmission to the acute hospital setting.  This acute hospital includes general and mental health in-patient services. 
  4. Support to General Nursing and AHP Training and Development: Provide an increased focus on education and training to improve the mental health skills of the general hospital staff by supporting training and development to ensure best practice and clinical excellence for psychiatry of old age patients in conjunction with Dementia Champions.A one and two year evaluation has now been completed with recommendation and approval to continue future investment in this service.  The future plan is to develop a support worker role so as to significantly increase the number of people supported by transitional care on discharge through a model of rehabilitative and supportive intervention.

It is also planned to provide  a ‘front of house’ discharge co-ordination to identify patients to return home or to a community facility who do not require to be in an acute inpatient bed.  This model will provide a senior clinical co-ordinator role with access to home care support workers, ‘access rights’ to Psychiatry of Old Age inpatient beds and other alternative admission services.

What were the outcomes - benefits or otherwise?

An evaluation of the service evidenced the following outcomes:

  • The Team had made a significant impact in improving care for PRI inpatients with a mental health need, leading to improved outcomes for their patients. Signposting and referral to community-based services increased, and there was a clear decline in transfers to psychiatric hospital.
  • The Team also increased early identification through speedier response time (from admission to referral) and provision of timely, specialist assessment. This is in line with a key clinical priority of the Scottish Government, set out in Standards of Care for Dementia in Scotland (Scottish Government, 2011).   As the team developed its service model and due to level of clinical expertise, the Consultant Psychiatrist input required decreased from an average of 12 hours to 6 hours per week.
  • Through the provision of transitional care, the Team improved continuity of care for people with an identified rehabilitation need, and closer integration of health and social care services through the case management approach taken by the Liaison clinicians.
  • Dementia Care Mapping evidenced the significant benefits of the volunteer support on the wellbeing and mood of inpatients with dementia, and also the impact of targeted staff training in improving patient/ staff interactions between the baseline and follow-up care mapping exercises.
  • In summary, the Team contributed to the core Change Fund and Reshaping Care for Older People aims in shifting the balance of care. This was achieved through reducing length of stay in hospital for their patients by an average of 3 days per patient (at the time of report-writing, this was equivalent to 1,200 bed days saved); and also achieving a reduction in hospital bed days lost to delayed to discharge for their patients.
  • In the 2 years that this team has been in place they have actively seen and assessed over 1000 patients. With an increase of 30% in referrals to the service between year one and two.
  • 6% increase in the number of patients with no follow up and a 2% decrease in the number of people being referred to OPCMHTs
  • Referrer feedback has been overwhelmingly positive with one referrer stating that the team ‘has made a dramatic difference to patient care (especially vulnerable patients), the Dementia Liaison Service has transformed our management of our most frail, vulnerable patients’.
  • Patient and carer stories have provided evidence that the team has contributed significantly to positive outcomes for patients and carers, through effective liaison, communication, specialist assessment and supported discharge

Contacts - to find out more

Gillian Irving,  01738 473132