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Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65

Published online by Cambridge University Press:  18 June 2021

Sarah Bradbury*
Affiliation:
Humber Teaching NHS Foundation Trust
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, University of Leeds
Manimegalai Chinnasamy
Affiliation:
Bradford District Care Trust
Laura Shaw
Affiliation:
Tees, Esk and Wear Valleys Foundation NHS Trust
Sara Ormerod
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust
Alison Wilkinson
Affiliation:
Cambridgeshire and Peterborough NHS foundation trust
Rebecca Chubb
Affiliation:
North Staffordshire Combined Healthcare Trust
Mazen Daher
Affiliation:
East London NHS Foundation Trust
Pramod Kumar
Affiliation:
Berkshire Healthcare NHS Foundation Trust
Andrew Gaskin
Affiliation:
South London and Maudsley NHS Foundation Trust
Karen Williams
Affiliation:
2gether NHS Foundation Trust; Justine Brennan-Tovey, Cumbria, Northumbria and Tees Valley NHS Foundation Trust
Angus Brown
Affiliation:
Cambridgeshire and Peterborough NHS foundation trust
Eleanor Stebbings
Affiliation:
South London and Maudsley NHS Foundation Trust
Sunita Sahu
Affiliation:
Oxleas NHS Foundation Trust
Roger Smyth
Affiliation:
NHS Lothian
Hilary Kinsler
Affiliation:
North East London NHS Foundation Trust
Stephen O'Connor
Affiliation:
North East London NHS Foundation Trust
Andrew Wells
Affiliation:
South London and Maudsley NHS Foundation Trust
Ross Overshott
Affiliation:
Greater Manchester Mental Health NHS Foundation Trust
Kehinde Junaid
Affiliation:
Nottinghamshire Healthcare NHS Foundation Trust
Aparna Mordekar
Affiliation:
Sheffield Health and Social Care NHS Foundation Trust
Jenny Humphries
Affiliation:
Avon and Wiltshire Mental Health Partnership NHS Trust
Karen James
Affiliation:
Hywel Dda University Health Board
Shweta Mittal
Affiliation:
Nottinghamshire Healthcare NHS Foundation Trust
Sarita Dasari
Affiliation:
Humber Teaching NHS Foundation Trust
Hugh Grant-Peterkin
Affiliation:
East London NHS Foundation Trust
Niall Campbell
Affiliation:
Cheshire and Wirral Partnership NHS Foundation Trust
Robert West
Affiliation:
University of Leeds
Professor George Tadros
Affiliation:
Birmingham and Solihull Mental Health NHS Foundation Trust
Elizabeth Sampson
Affiliation:
Barnet, Enfield and Haringey Mental Health Trust and University College London
*
*corresponding author.
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Abstract

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Aims

The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.

Method

We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.

Result

Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.

Conclusion

To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.

The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.

Type
Service Evaluation
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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